
5 r\r~ 



Class. T\ lz2 



- 



Bock_ 

CqpigfeM. 



__ 



COPYRIGHT DEPOSIT 



THE TREATMENT 

of 

EMERGENCIES 



fly 

HUBLEY R. OWEN, M. D. 

RGEON TO THE PHILADELPHIA GENERAL HOSPITAL; ASSISTANT EUEGBON TO T^r. 
PHILADELPHIA ORTHOPEDIC HOSPITAL AND INFIRMARY FOR NERVOUS !>!si. \- 
CHIEF SURGEON OP THE PHILADELPHIA POLICE AND EIRE BUREAUS; 
ASSISTANT SURGEON, MEDICAL RESERVE CORPS, V. S. NAVY 



WITH 249 ILLUSTRATIONS 



PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 

1917 






Copyright, 191 7, by W. B. Saunders Company 




JUN 28 1917 



PRINTED IN AMERICA 



PRESS OF 

W. B. SAUNDERS COMPANY 

PHILADELPHIA 



^CI.A470106 



THIS BOOK 
IS DEDICATED TO 

J. CHALMERS DaCOSTA, M. D., LL. D. 

GROSS PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLI G] 

SURGEON OK THE FIREMEN'S PENSION FUND, AND BURGEON <>l 

THE FIRE INSURANCE PATROL OF PHILADELPHIA 

WHOSE ADVICE I HAVE SOUGHT MANY TIMES DURING MY 

TENURE OF OFFICE AS SURGEON TO THE POLICE 

AND FIRE DEPARTMENT OF PHILADELPHIA 

AND 

WHO HAS HELPED ME IN MANY WAYS WITH 
THE WRITING OF THIS BOOK 



PREFACE 



This book is essentially an enlargement of my lectures to 
the policemen and firemen of Philadelphia, which were deliv- 
ered at the training schools of those departments; and of my 
lectures to nurses in two of the City hospitals. 

While collecting data for these lectures I was unable to 
find a book on First Aid or the Treatment of Emergencies in 
which the principles of and the reasons for the application of 
first-aid dressings were fully discussed. I have examined hun- 
dreds of students of first aid who could do the practical work 
and answer examination questions in a poll parrot manner, but 
who had no idea of the underlying principle of the dressing 
and the reason for a particular method of application. 

The criticism of the book may well be that it is too technical 
for the layman and that many procedures recommended would 
be too dangerous for him to undertake. My defence as to this 
criticism is, that unless a person wishes to become well versed 
in the treatment of emergencies it would not be wise to 
undertake the subject at all. The mere tyro in first aid is the 
one who usually comes to grief and many of the manuals on 
first aid still leave their students tyros because they fail to 
teach those most necessary underlying principles. 

I have been not only encouraged, but agreeably amazed 
at the progress of the firemen in grasping the subject of First 
Aid. 

This book has been written primarily for the instructors 
of first aid to the injured, for police and fire surgeons, for 
ambulance surgeons, for resident physicians, for nurses, and for 
those laymen who wish to make a more comprehensive study 
of the subject. 

I wish to extend my thanks to all those who have helped 
me with the publication of this book, to the policemen and 
firemen who posed for many of the photographs, and to 

11 



12 PREFACE 

Mr. Harry Bodkin, official photographer of the Police De- 
partment, who made many of the pictures. My thanks are 
also due to Dr. John F. X. Jones, who assisted me with the 
correction of the proof. 

Htjbley R. Owen. 
Philadelphia, Penna., 
June, 1917. 



CONTENTS 



CHAPTER I 



PAGE 

Fractures 17 

First Aid Treatment for Fractures of Individual Hones. 22 

CHAPTER II 

Contusions and Wounds 63 

Contusions of Special Parts 65 

Contused and Lacerated Wounds 67 

Incised Wounds 77 

Punctured Wounds 80 

Stab Wounds s; 5 

Poisoned Wounds s I 

Gun Shot Wounds 02 

CHAPTER III 

Hemorrhage 98 

Hemorrhage from Particular Regions Ill 

CHAPTER IV 

Sprains and Dislocations 122 

Sprains 122 

Dislocations 129 

Dislocations of Special Parts 130 

CHAPTER V 

Burns and Scalds 136 

CHAPTER VI 

The Effects of Heat and Cold upon the Tissues 143 

Sunburn and Frost Bites 143 

CHAPTER VII 

Asphyxiation 145 

Artificial Respiration 152 

13 



14 CONTENTS 

CHAPTER VIII 

PAGE 

Drowning 162 

CHAPTER IX 
Convulsions 169 

CHAPTER X 
Unconsciousness 172 

CHAPTER XI 

Effects Produced by Lightning 184 

CHAPTER XII 

Foreign Bodies 191 

CHAPTER XIII 

Antiseptics 198 

Germicidal Agents 198 

CHAPTER XIV 

Bandaging 205 

Varieties of Bandages 212 

Bandages of the Head 231 

Bandages of the Shoulder 243 

Bandages of the Hand and Fingers 251 

Bandages of Upper Extremity 255 

Bandages of Forearm and Arm 257 

Bandages of the Chest 261 

Bandages of the Lower Extremity 268 

CHAPTER XV 

Transportation 277 

Stretchers 300 

CHAPTER XVI 

Poisons and Their Treatment 310 

Metals 312 



CONTENTS 



15 



Acid* 315 

Alkalies ' il7 

Volatile Liquids 

Narcotics \' t )} 

Depressants '.'"" 

Miscellaneous Poisons **J 

Necessities for Receiving Ward Treatment of Poisons 327 

CHAPTER XVII 

Household Remedies 



, 335 

Index.. . . 



TREATMENT OF EMERGENCIES 



CHAPTER I 
FRACTURES 

A fracture is a break of a bone caused by sudden force. 
There is no difference between a fracture and a break. In 
surgical writings the two words are synonymous. A bone 
may be broken in three ways, either by direct force, by indirect 
or transmitted force or by muscular action. For example, if 
a man were struck on the arm with a club and the arm were 
broken, at the point struck, we would speak of the injury as a 
fracture by direct force. If, however, a man should fall upon 
the palm of his outstretched hand, the bones of the hand and 
the bones of the arm escaping injury but the force, being trans- 
mitted to the collar bone, should break that bono, we would 
say that fracture was caused by indirect or transmitted force. 
If a person, when running or walking, were suddenly to strike 
or catch the foot against a heavy object while the knee was 
bent, the sudden contraction of the heavy thigh muscles 
might fracture the knee cap. This would be a fracture by 
muscular action. Another example of a fracture by muscular 
action would be a fracture of one of the bones of the arm 
sustained while throwing a ball or a stone. 

There are two main divisions of fractures: simple fractures 
and compound fractures. A simple fracture is a fracture in 
which there is no surface wound communicating through the 
soft parts with the line of fracture. A compound fracture is 
an open fracture or a fracture in which the wound reaches 
from the surface of the skin directly down to the line of frac- 
ture, thus putting the line of fracture in direct communication 
with the skin-surface and the outside air (Fig. 1). It must be 
2 17 



18 TREATMENT OF EMERGENCIES 

thoroughly understood that a bone does not have to pierce or 
protrude through the skin in order for the fracture to be consid- 
ered compound. A primary compound fracture is a compound 
fracture produced at the time of the injury; that is, a man 
may fall and break a bone of his leg and the bone may be driven 
through the skin at the time of the fall, or a wound down to 
the line of fracture may be caused by the force which produced 
the fracture. On the other hand, if a man were to fall and 
receive a simple fracture of one of the bones of his leg and 



Fig. 1. — Compound fracture (Da Costa). 

through subsequent rough handling, lack of fixation or slough- 
ing of the soft parts, the bones were forced through the skin, 
that would constitute a secondary compound fracture. A 
green-stick or bent fracture is an incomplete fracture (Fig. 2) . 
The bone is broken on its convex surface only as a green stick 
breaks when bent across the knee. Such a fracture can only 
occur in a young person and is rare excepting in childhood. 
Care must be taken that such a fracture is not made complete 
by rough handling. A multiple fracture is a fracture in which 
there are more than two fragments, the lines of fracture not 
communicating with each other (Fig. 3). A comminuted frac- 
ture is a fracture in which there are more than two fragments, 
the lines of fracture communicating with each other. It is a 
splintering of bone (Fig. 4). 

Symptoms of Fracture. — There are five signs by which a 
fracture may be recognized. Not all of them are invariably 



FRACTURES 



19 



present. These signs are: pain, including tenderness; crepitus 
or crackling, which may be sometimes heard and often felt ; 
unnatural mobility of the part (an ability to bend the limb 
where it should not bend); deformity; and loss of function of 
the part (for instance, inability to walk after a break of the 
thigh bone). Pain is present in practically all fractures and 





Fig. 2. — Green-stick 
fracture (Da Costa). 



Fig. 3. — A multi- 
ple fracture. 



Fig. 4. — A comminuted 
fracture (Da Costa). 



is especially severe when any attempt is made to move the 
part that is broken. Tenderness is an important sign of 
fracture. The surrounding soft parts may be also tender, but 
the more acute tenderness is directly over the site of the 
fracture. 

Crepitus is a grating or a crackling caused by two rough 
fragments of bone being rubbed together. It can be felt and 



20 TREATMENT OF EMERGENCIES 

can sometimes be heard. Rough handling to elicit crepitus 
may do damage. It should not be attempted by a layman 

Unnatural mobility is a most important sign, and when it is 
present a fracture undoubtedly exists. By unnatural or pre- 
ternatural mobility, we mean there is abnormal motion at the 
site of fracture; that is, if the bone of the upper arm between 
the shoulder and the elbow is broken the two fragments can 
be made to move upon each other. There is, so to speak, a 
joint where no joint should be. Movement may cause angu- 
lation and deformity. 

Another sign of fracture often present is the fact that one 
portion of a bone can be moved without moving the other por- 
tion. When this is manifest it is one of the examples of pre- 
ternatural mobility. Again, when the shaft of a bone is 
broken, if the head of the bone is held with the fingers of 
one's hand and the shaft below the break is rotated with 
the other hand, the head of the bone does not move. 

The deformity of a fracture depends upon the amount of 
swelling of the soft parts and upon the amount of displace- 
ment of the fragments. The deformity may be slight or may 
be great. It requires prompt reduction. Reduction of de- 
formity, that is, getting the ends of the broken bones together 
and getting the bones in alignment, is known as " setting the 
fracture." A deformity if left unreduced will become worse 
and permanent. A deformity, though once corrected, may 
recur because of faulty support. Union of the fracture with 
deformity may not only be disfiguring but may render the 
part partially or wholly useless. If a fracture is put at rest 
upon a splint or is secured by some other form of apparatus 
which will insure immobilization soon after the injury is re- 
ceived, the likelihood of deformity is not nearly so great as 
if the fracture is untreated for a number of hours or days. 

Loss of function of the part is by no means a constant sign 
but, when present, is important. A person can often walk in 
spite of a fracture of the fibula (the smaller of the two bones 
leading from the knee to the ankle), or he may be able to use 
the forearm to some extent, though there is a fracture of the 
radius (the smaller of the two bones leading from the elbow 
to the wrist), but if the bone of the upper arm (the humerus) is 



FRACTURES 21 

broken or if the bone of the thigh (the femur) is broken, the 
corresponding extremity is usually incapable of function. 

General Consideration of First-aid Treatment of Fractures. 
— Whenever there is a history of a severe injury to a bony part 
and that part immediately becomes the seat of pain, tenderness, 
and swelling, a fracture should be suspected. It is never wise 
for a layman to manipulate a part in order to elicit crepitus 
and unnatural mobility. Great harm may be done by rough 
handling. Blood vessels may be torn, nerves injured, soft 
parts damaged, or a simple fracture may be made compound. 
If a fracture is suspected the part should be immediately put 
at rest. It is far belter to be overcautious and occasionally 
to splint a part when no fracture exists than to be bo careless 
as to allow a fracture to go untreated without the application 
of a splint or dressing to keep the part at. rest. Even if the 
part is not the seat of a fracture, but is only severely bruised 
or sprained, the splint or dressing to put the part at rest, may 
do much good and can do no harm, if it is properly applied. 

The main object of the first treatment of all simple fractures 
is to prevent movement of the bone fragments. Movement 
causes pain, tears the surrounding tissues and may convert a 
simple fracture into a compound fracture. Blood vessels and 
nerves are in close proximity to bone and by rough hand- 
ling the sharp ends of a broken bone may tear the main artery, 
vein or nerve of a part. Such an injury may necessitate am- 
putation because division of the main artery may be followed 
by gangrene. 

The first aid treatment of a compound fracture must be 
directed toward the prevention of any further damage by the 
fragments of bones and toward keeping the open wound clean 
from infection. Many arms and many legs have come to 
amputation because of the fact that the wound leading to the 
seat of fracture became hopelessly infected from careless 
handling. If a compound fracture can be seen by a physician 
within a few hours, the layman should not attempt to cleanse 
the wound but should only seek to keep it clean by laying a 
piece of sterile gauze or a surgical dressing over the wound and 
applying a bandage. The part is then put at rest upon a 
splint. If a 2 per cent, solution of iodine is available the 



22 TREATMENT OF EMERGENCIES 

wound should be swabbed with this solution before the dress- 
ing is applied. 

If, however, the case can not be seen by a physician for 
twelve hours or more the wound should be cleansed with 
peroxide of hydrogen, in the strength of 1 part of peroxide and 
3 parts of water, the water having been previously boiled. 
Foreign bodies should be removed from the tissues, a wick of 
sterile gauze one inch wide should be placed in the wound to 
secure drainage, a piece of sterile gauze should be placed upon 
the wound and bandages and a splint should be applied. 
The splint or other immobilizing apparatus used depends upon 
the bone involved, and the materials applicable as supports 
which may be at hand. 

FIRST AID TREATMENT FOR FRACTURES OF INDIVIDUAL 

BONES 

Fractures of the Skull. — Not a great deal can be done by 
first aid methods for fractures of the skull. A few things, how- 
ever, should be done. It is highly important to be able to 
recognize a fracture of the skull and to know the' symptoms 
which may arise and the manner in which they develop. 
There are two main groups of fractures of the skull classified 
according to the situation; namely, fractures of the vault of 
the skull, and fractures of the base of the skull. The vault of 
the skull is that rotund part of the skull which protects the 
brain. It is the entire area over which the scalp moves and 
it extends from the eyebrows in front to the ears on the sides 
and to the nape of the neck behind. Any portion of the 
vault may be fractured. There may be only a slight crack or 
fissure in the bone with no separation, a fracture which is 
very difficult to diagnose. On the other hand, there may be 
a fracture with wide separation, splintering of bone, or marked 
depression. By depression, we mean that a piece of bone has 
been driven down toward the contents of the skull and has 
perhaps injured the brain or a blood vessel within the skull. 
The depression, if marked, can be felt by the examining 
finger. 

The chapter of emergency work in police stations is an unfor- 
tunate one, in so far as it deals with fractures of the skull. Some- 



FRACTURES 23 

times the fracture is not suspected and a prisoner or a patient, 
whichever he may be, is locked up in a cell or is discharged 
with a diagnosis of drunkenness plus contusion or laceration 
of the scalp when a fracture actually exists. It is usually in 
the case of an alcoholic that such a mistake is made. The 
subsequent development of such cases is apt to be most disas- 
trous. To obviate these blunders, it is now the rule in hospi- 
tals that all cases of head injuries should be retained in the 
hospital at least twenty-four hours for observation. A 
lacerated wound of a scalp is freely opened by the surgeon to 
determine by sight and touch if fracture of the skull exists. 

The rule now in force in the police stations of Philadelphia 
has taken from the house sergeant and turnkey their old-time 
jobs of surgical diagnostician and every man with a lacerated 
or contused wound of the scalp or any other head injury 
must be examined by a district police surgeon. If there is 
even a suspicion of fracture of the skull, the prisoner is sent 
at once to the nearest hospital to be placed under observation. 
If such a rule as this is rigidly enforced, we will see fewer 
accounts of prisoners arrested for drunkenness but dying in 
station houses from fractures of the skull. A special provi- 
dence may at times watch over the drunken man but unfor- 
tunately that special providence does not always keep the 
drunken man from receiving a fractured skull, nor does it 
help the policeman to diagnose the case. 

A fracture of the base of the skull is a fracture of that part 
of the skull on which the brain rests. The base of the skull is 
shown in Fig. 5. It will be seen that there are several canals 
or channels leading out of the skull. For demonstration a 
piece of whale bone has been passed through each canal. 

A leads from the base of the skull to the nose. B leads from 
the base of the skull to the orbit and C leads from the base of 
the skull to the ear. Blood vessels run through all of these 
canals. If a fracture of the base of the skull extends into 
any one of these canals, blood is likely to find its way along 
the canal and enter the part into which the canal runs. 
This blood may come from the line of fracture, may come 
from injury to the soft parts, or may come from rupture of 
large vessels. 



24 



TREATMENT OF EMERGENCIES 



The blood may find its way through the canal or along 
the line of fracture. In a fracture of the base of the 
skull the blood may escape into the nose causing nose 
bleed (epistaxis) ; the blood may escape into the ear and, if 
there has also been a rupture of the ear drum, there will be 
bleeding from the ear, or the blood may escape into the orbit 
turning the white of the eye red, a condition known as ecchy- 
mosis beneath the conjunctiva or subconjunctival ecchymosis. 




Fig. 5. 



-Showing base of skull with probes passed from orbit, nose, 
and ear to base of skull. 



Therefore, bleeding from the nose, bleeding from the ear or 
hemorrhage into the white of the eyeball, following a head 
injury, should be regarded as serious. 

Following or during such bleeding from the ear or nose there 
may be an escape, drop by drop, of a clear colorless fluid. 
This is the fluid which bathes the brain and spinal cord. It 
is called the cerebro-spinal fluid. The escape of such fluid 
from the nose or ear makes positive the diagnosis of fracture 
of the base of the skull. 

Associated with the above conditions the patient nearly 
always suffers from concussion of the brain. There is usually 



FRACTURES 25 

severe headache and vomiting unless the patient is unconscious. 
When unconsciousness is present in fractured skull, the patient 
can not be aroused. The breathing is slow, deep, and noisy, the 
cheeks vibrating during every expiration. 

The emergency treatment of fractures of the base of the 
skull is mainly that of the treatment of concussion of the brain 
(see page 174). The patient should be placed in the reclining 
position with the head slightly raised, either on a pillow or a 
folded sheet and a blanket is thrown over him for warmth. 
All clothing is loosened. If the patient is conscious and able 
to swallow, give a teaspoonful of aromatic spirits of ammonia 
well diluted with water. Never give whiskey nor any other 
alcoholic stimulant to anyone who has suffered a head injury 
as it adds to the subsequent congestion of the brain. 

The nose and ears should be kept clean, perferably by 
temporarily placing cotton in the nostrils and in the ears. 
By so doing one may prevent infection of the blood or of the 
cerebro-spinal fluid, and a subsequent fatal inflammation of the 
brain. Merely place a loose pledget of cotton in the nose and 
ears to keep dirt from entering and convey the patient to a hos- 
pital with all speed. The cotton is kept in t he nose and ears tem- 
porarily only, otherwise it would cause damming up of the dis- 
charge. When the patient reaches the hospital the ears, nose 
and throat are thoroughly cleansed with boric acid solution 
and iodoform powder is blown into the ears and nose for dis- 
infection. The patient is kept in a quiet, dark room. 

Fracture of the Vault of the Skull.— The vault of the skull 
is the rotund area which protects the brain from injury. A 
fracture of the vault of the skull is due to direct violence. 

A fracture may involve the vault alone but in 50 per cent, 
of the cases the base of the skull is also involved. A fracture 
of the vault may be a line or linear fracture, a depressed frac- 
ture or an undepressed fracture. The fracture may be simple 
or compound. A line fracture or linear fracture or a split 
in the bone is often difficult to recognize. A fracture with 
marked depression can be readily recognized. In a suspicious 
case a physician cuts down upon the site of injury and inspects 
the bone. If the fracture is compound the existing wound 
is enlarged sufficiently for the physician to inspect the underlying 



26 TREATMENT OF EMERGENCIES 

bone. Any head injury should be regarded as serious until 
the case has been examined by a physician. 

Treatment. — The first aid treatment of a suspected fracture 
of the vault of the skull is the same as that for fracture of the 
base of the skull and concussion (see page 25). 

If the fracture is compound, the head should be shaved, the 
wound painted with iodine and a surgically clean dressing 
applied. The patient is then treated as for concussion of the 
brain until a physician arrives. 

W--- ....-,_.. ._ "^1 





Fig. 6. — Linear fracture of the skull showing area of bone removed for 

decompression. 

Fracture of the Nose. — There are two parts of the nose 
which may sustain a fracture : either the nasal bones which are 
the external bones of the nose (the bones which maintain the 
outward appearances of the nose) or the septum of the nose, 
the septum being the interior bony partition which separates 
the nostrils. 

Fracture of the nose can be caused by a direct blow only, 
never by muscular action. A fracture of the nose is often 



FRACTURES 27 

compound, as the blow 1o the nose may inflict a wound which 
communicates with the line of fracture, or the bones are often 
driven through the mucous membrane of the nostril making 
the fracture compound by giving the outside air access to the 
seat of fracture. Severe epistaxis or nose bleed is usually- 
associated with fracture of the nose. 

Treatment. — The nose bleed must first be checked. If the 
bleeding is moderate, sniffing cold water or dropping undi- 




FiG. 7. — Dressing for fracture of the nose. 

luted peroxide of hydrogen into each nostril by means of an 
eye dropper may stop it, but if bleeding is severe each nostril 
must be plugged with a piece of cotton or gauze. Iodoform 
gauze is better than plain gauze as it tends to disinfect the 
parts if the fracture is compound through the mucous 
membrane. 

If clots form in the nostril, do not blow the nose nor try to 
wash the clots out as the formation of blood clot is nature's 
method of checking hemorrhage. 



28 TREATMENT OF EMERGENCIES 

To hold the nasal bones in place until the surgeon is seen, a 
piece of adhesive plaster is cut into the shape of a dumb-bell or 
a butterfly; the narrow part of the adhesive plaster is placed 
across the bridge of the nose and the broad flaps extend out 
over the cheeks. On either side of the nose under the adhesive 
plaster is placed a small roll of cotton or gauze, as in Fig. 7, 
so as to make pressure. If the fracture is compound through 
the skin over the bridge of the nose a piece of gauze preferably 
iodoform gauze is placed over the wound on the bridge of the 
nose before applying the adhesive plaster. 

A Fracture of the Septum. — A fracture of the septum of the 
nose should, if possible, be straightened and both nostrils be 
packed with strips of gauze or with cotton. 

Fracture of the Lower Jaw. — Fracture of the lower jaw is a 
rather common injury. It is especially common among 
pugilists. The injury is not infrequently seen in the fire and 
police departments. The victim suffers great pain. The 
bone is usually broken to the right or left of the midline, just 
below one of the eye teeth. The gum over the site of the 
fracture swells rapidly. The fracture is usually compound, 
one of the fragments being driven through the gums. Crepi- 
tus and preternatural mobility are present. The gum, being 
lacerated, bleeds freely. Bloody saliva dribbles from the 
mouth. Some of the teeth are loosened and one or more may 
be knocked out at the time of the injury. The natural 
alignment of the teeth is distorted. 

Treatment. — If the bleeding of the gums is severe it must be 
checked. This may be accomplished by means of direct pres- 
sure upon the bleeding gums. Take a piece of clean gauze or 
cotton and make the pressure by holding the material over 
the point of the bleeding. If the fracture is compound 
through the gums, cleanse the mouth at once by rinsing the 
cavity with a dilute solution of hydrogen peroxide (1 part of 
peroxide to 3 parts of water) or with boric acid solution. Do 
not extract any teeth which may be loosened, as the surgeon 
or a dentist may be able to save the teeth. Detached teeth 
should be placed back into their sockets. 

The two fragments of the broken bone are pressed against 
the upper jaw. The teeth are thus brought into normal align- 



FRACTURES 



29 



ment. The upper jaw acts as a splint. A dressing is ap- 
plied to hold the broken jaw against the upper jaw. The 
simplest form of such a dressing is an ordinary handkerchief, 
a necktie or a triangular bandage folded into a scarf. This is 
carried under the jaw in front of the ears and over the top 
of the head where it crosses; it is then carried back of the ears 
to the undersurface of the chin where it is tied (Fig. 8). 




Fig. 8. — Cravat bandage for fracture of jaw 



Another simple dressing is made by taking a piece of linen, 
muslin or flannel, about four inches wide and thirty inches 
long and making a four-tailed bandage. 

The middle untorn portion is placed under the lower jaw; 
the free ends of that portion of the bandage under the jaw are 
then carried over the top of the head and tied; then the free 
ends of the part of the bandage in front of the jaw are carried 
around the neck and tied. All four of the ends are then tied 
together to keep the bandage from slipping. The complete 
dressing is shown in Fig. 9. Other dressings for fracture of 
the lower jaw are Barton's bandage and Gibson's bandage (see 



30 



TREATMENT OF EMERGENCIES 



pages 232, 233) and the Barton bandage made with a cravat 
as shown in Fig. 153. 

Fracture of the Collar Bone or Clavicle. — The collar bone 
is one of the most frequently fractured bones of the body. 

The collar bone extends from the breast bone to the shoulder. 
It is usually fractured near the shoulder, that is, at the junc- 
tion of the outer third of the bone with the middle third. 




Fig. 9. — Four-tailed bandage for fracture of the jaw. 

The fracture may be caused by direct violence as a blow or 
a kick directly against the bone. Such a blow is often received 
when a football player makes a hard tackle, the knee of the 
runner striking and perhaps fracturing the collar bone of the 
tackier. 

The collar bone may be broken by indirect or transmitted 
force, as when a man falls heavily upon the shoulder, the elbow 
or the outstretched hand, the force being transmitted from 
its point of application to the collar bone and thus break- 
ing the bone. The ends of the fragments can be felt by the 
examining finger and both crepitus and unnatural mobility 
are readily appreciable. 



fractures 31 

The collar bone is the main bone which maintains the posi- 
tion of the shoulder. When this bone is broken, the position 
of the shoulder is, therefore, altered. The bone tends to hold 
the shoulder away from the body. When the collar bone is 
broken, the shoulder, therefore, tends to crowd upon the chest. 
It is pulled inward by the heavy chest muscles. The collar 
bone braces the shoulder back. When the bone breaks, the 
prominence of the shoulder is pulled forward. The collar 
bone also helps to maintain the weight of the arm. When, 
therefore, the collar bone is broken, the shoulder tends to sag 
down because of the weight of the arm. The displacement 
of the shoulder after this fracture is downward, forward, and 
inward. 

Pain and tenderness over the seat of the fracture are always 
present. The patient usually holds the elbow of the injured 
side in the sound hand in order to relieve the weight of the 
arm. The head is inclined toward the injured bone because 
the big muscles of the neck are attached to the collar bone, 
and when the bone is broken these muscles tend to pull the 
Jnner fragment upward. The patient, inclines the head to 
the injured side so as to relax the pull of the muscles and 
consequently to relieve pain. 

Treatment. — The best emergency dressing for fracture of 
the clavicle is the application of a posterior figure-of-eight 
bandage of the shoulder and the placing of the forearm of the 
injured side in a sling. 

By the application of the posterior figure-of-eight of the 
shoulders the deformity is partially corrected, as the shoulder 
is pulled back into its normal position and the traction of the 
muscles of the chest is overcome. 

The arm of the injured side is then put in a sling in order that 
the broken bone may be relieved of the weight of the arm. 
The figure-of-eight of the shoulders is applied as on page 264. 
Another dressing for fracture of the collar bone is the Sayre 
dressing. To apply this dressing take two pieces of adhesive 
plaster about three inches wide. The end of the first piece 
encircles the arm of the injured side below the arm pit. The 
plaster is then carried around the back to the front of the 
chest. This procedure pulls the elbow back and throws the 



32 TREATMENT OF EMERGENCIES 

shoulder out. The hand of the injured side is now placed on 
the breast of the opposite side, a piece of cotton or lint being 
interposed between the skin of the chest and the palm of the 
hand. The second strip of adhesive plaster extends from the 
elbow of the injured side to the front of the opposite shoulder 
around and back pressing the elbow upward, forward and 
inward (see Figs. 11 and 12). The cravat bandage for frac- 
ture of the collar bone is shown in Fig. 10. 




Fig. 10. — First aid dressing for fracture of right collar bone. The 
posterior figure-of-eight is applied with a cravat bandage and the arm 
is placed in a sling. A roller bandage may be applied to hold the arm 
of the injured side to the chest. 

If a young woman sustains a fracture of the collar bone 
it is important that she will have no subsequent deformity. 
The best first aid treatment which can be employed is to put 
her in the reclining position and to place under her shoulders 
a board about six inches'wide, so that she can lie with her 
shoulders on this board. The arm of the injured side is 



FRACTURES 33 

bandaged close to her side. Directly over the broken collar 
bone is placed a bag of sand or shot weighing about five pounds. 
The fragments will be kept practically motionless until the 
surgeon arrives (Fig. 13). 

Fracture of the collar bone is rarely compound. If it is 
compound, paint the wound with iodine, place a clean or 
sterile dressing over the wound, apply posterior figure-of- 
eight bandage of the shoulders and place the arm in a sling as 
described above. 




Fig. 11. — Dressing for fracture of the collar bone. Front view 

Fracture of the Upper Arm. — The upper arm is that part of 
the arm which extends from the shoulder to the elbow. There 
is but one bone in the upper arm. This bone is called the 
humerus. It is frequently broken, usually by direct force, 
sometimes by indirect force or by muscular action. 

A broken arm must be handled with the greatest care and 
gentleness as by rough handling the artery or nerves which 
supply the arm may be cut by the jagged end of one of the 
fragments and serious results may follow. If the injury be 



34 



TREATMENT OF EMERGENCIES 




Fig. 12. — Dressing for fracture of the collar bone. Back view. 
See also Fig. 131 for dressing for fracture of the collar-bone 













h. ; 


-rW^' . 


V' T^ 


^ 


^ 


^ 


i 


1 


L- .._.:• 


,^x^ 


gpg^ 


55 




. 



Fig. 13. — First aid dressing for woman with fractured collar bone. 
Arm of injured side bandaged to chest and sand bag over injured collar 
bone. 



FRACTURES 



35 



severe the arm may subsequently require amputation. If 
the nerves be injured, paralysis may ensue. 

Fig. 14 shows the close relation of the vessels and nerves 
of the arm with the bone and Fig. 15 shows how injury to the 




Fio. 14. — Shows close relation of the bone bo the vein, artery, and nerve 
of the upper arm. 

vessels or nerves may occur. These important vessels and 
nerves lie almost directly against the bone. 

The indications of a fracture of this bone are pain and 
tenderness especially acute over the site of the fracture, crepi- 
tus or the grating sensation of the fragments, deformity, 
unnatural mobility and loss of function of the arm. A sur- 




Fig. 15. — Shows how injury may occur to vein, artery, or nerve following 
fracture of bone of upper arm. 

geon should feel for the radial pulse to ascertain whether or 
not the blood supply to the arm has been injured. 

It is not advisable for a layman to try to elicit crepitus or 
unnatural mobility, for by doing so the harm we are warding 
against, namely, injury to vessels or nerves, may occur. 



36 TREATMENT OF EMERGENCIES 

Following a severe blow or injury to the upper arm, if there 
is acute pain and tenderness, and the victim is unable to use 
the arm, suspect a fracture and treat it as such until the 
surgeon can examine the arm. It may be that the injury 
will prove to be a severe contusion and not a fracture, but in 
such a case rest to the arm will surely be ordered by the sur- 
geon, and the application of the first aid dressing will have 
accomplished its purpose by putting the part at rest. 




Fig. 16. — First aid dressing for fracture of upper arm. 

Treatment of Fracture of the Upper Arm. — The upper arm 
must be placed between two splints. What two splints 
can we use? Nature has given us one of the splints, namely, 
the chest wall. By placing the upper arm against the 
chest wall it will be seen that it fits snugly. This then 
is the internal splint. As an external splint we may use 
a padded shingle, a piece of cardboard or a folded piece of 
heavy paper. The upper arm is placed snugly against the 
chest and the shingle is placed against the outer surface of 



I RACTURES 37 

the upper arm. A bandage is then placed around the shingle 
so as to include in each turn the arm and chest, as is shown 
in Fig. 16. 

When a splint is applied to the outer side of the arm the 
bony prominence at the elbow is pressed upon by the splint. 
It is, therefore, necessary to put padding over this bony 
prominence to relieve irritation or ulceration of the skin. 

The forearm is then put in a sling. 

The fracture of the upper arm may be compound. After 
hemorrhage is stopped the wound should be painted with iodine 
and then covered with a piece of sterile gauze or if sterile gauze; 
is not obtainable with the cleanest piece of material which can 
be found. A bandage is applied around the arm to hold this 
dressing in place. The arm is then placed upon a splint as 
has been described above. 

Fractures In and About the Elbow Joint. — Fractures in or 
about the elbow joint are always serious. Their seriousness 
depends upon the fact that there is great likelihood of subse- 
quent stiffness of the elbow joint. Any injury in or about 
the elbow joint, if accompanied by tenderness and pain, the 
pain being greatly aggravated by motion of the elbow joint, 
must be regarded and treated as a fracture until examined by a 
surgeon. No manipulation of the joint should be attempted. 
The arm should be put at rest and held in the position most 
comfortable to the patient until a surgeon can be seen. Usu- 
ally the most comfortable position is with the forearm at a 
right angle to the arm. The extremity is placed in a sling 
to support the elbow and forearm. Compound fracture of 
the elbow is not common. 

Fractures of the Forearm. — The forearm is that part of the 
arm extending from the elbow to the wrist. There are two 
bones of the forearm as shown in Fig. 17. One bone is called 
the ulna. This is the main supporting bone of the forearm 
at the elbow. The other bone is the radius so called because 
it rotates when the hand is turned. Either or both of these 
bones may be broken. When one of these bones is broken, 
pain, tenderness, and usually crepitus are present, but because 
of the fact that the unbroken bone tends to support the forearm, 
preternatural mobility is not as conspicuous as in fracture of 



38 



TREATMENT OF EMERGENCIES 



the bone of the upper arm. If both bones of the forearm are 
broken (Fig. 18) in addition to pain, tenderness and crepitus, 
there is usually deformity and unnatural mobility. There is 
usually loss or limitation of function of the forearm, that 
is, inability to turn the hand. These movements are called 
supination and pronation. Even though both of the bones 
may be broken the fingers can still be moved. Usually such 
movement of the fingers causes pain as the muscles which 



Fig. 17. — The bones of the forearm. 



move the fingers may have been included in the injury at 
their points of origin from the bones. 

Treatment of Fractures of the Bones of the Forearm. — The first 
aid treatment of fractures of one or both bones of the forearm 
consists in placing the forearm on a splint. The splint should 
reach from the elbow to the tips of the fingers and it should be 
wider than the arm. The splint in Fig. 19 is of the correct 
width and length. The splint shown in Fig. 20 is incorrect 
as it is neither wide nor long enough. The splint is held in 



FRACTURES 



39 



place by adhesive strips or preferably by a roller bandage. It 
is most important to remember that a bandage applied to 
the forearm should include the hand. This rule is imperative 
in order to prevent subsequent swelling of the hand and great 



Fig. 




Fracture of both bones of the forearm t,Da Costa). 



pain. The correct and completed dressing with the arm in a 
sling is shown in Fig. 19. The splint is an ordinary shingle. 
It is important to place a pad under the bony point of the 
elbow so that the pressure of the splint will not cause pain, 
inflammation, perhaps ulceration. The dressing will be more 



40 



TREATMENT OF EMERGENCIES 



comfortable if another pad or a handkerchief is placed under 
the palm of the hand so as to maintain its normal arch. 




Fig. 19. — First aid dressing for fracture of the forearm. 




Fig. 20. — Incorrect splint for fracture of bones of forearm, splint being 
neither long enough nor wide enough. 

If a fracture of the forearm is compound, after stopping the 
hemorrhage, a piece of sterile gauze or a piece of clean linen 
should be placed over the wound. The wound may be 



FRACTURES 



41 




Fig. 21. — Lcvis'.s radius-splints, right and left, for fracture of the lower 
end of the radius. 




Fig. 22. — Emergency kit carried on Philadelphia fire trucks and patrol 

wagons. 



42 



TREATMENT OF EMERGENCIES 



swabbed with a solution of iodine before the dressing is 
applied. 

The emergency kits of the fire trucks of the Philadelphia 
Fire Department carry the Levis splint. It is made of tin 
and is very light. This splint is used for injuries to the fore- 
arm and wrist. The Levis splint is shown in Fig. 21. 

A picture of the kit with contents is shown in Fig. 22. 

Colles , Fracture. — A fracture of the lower end of the radius 
as shown in Fig. 23 is called 001168' fracture. It is one of the 




Figs. 23 and 24. — Deformity at the wrist consequent upon displacement 
backward of the lower fragment of the radius after fracture at its lower 
extremity (Levis). 



most common of fractures and is usually the result of a fall 
upon the palm of the outstretched hand. It is often very diffi- 
cult to tell the difference between Colles' fracture and a 
sprain of the wrist, and any injury about the wrist accom- 
panied by severe pain and by tenderness should be considered 
Colles' fracture until the contrary is proved. 

Crepitus can seldom be elicited in a Colles' fracture. There 
may be deformity. The characteristic deformity of Colles' 
fracture is shown in Figs. 23 and 24. A Colles' fracture should 
be treated by the application of a splint applied to the palmar 
aspect of the hand. The splint should extend from the tips 
of the fingers to a point halfway between the wrist and the 



FRACTURES 43 

elbow. The splint should be padded and should be wider 
than the part to which t is applied. 

Fractures of the Hand. — The bones of the hand are broken 
by direct violence usually by a blow struck with the fist. It 
is an injury common to prize fighters. When a pugilist 
once breaks his hand, his fighting days are usually over as he 
seldom recovers the ability to deliver his former blows. He 
is afraid to hit hard for fear of rebreaking the hand. When 
the hand is broken there is great pain when an attempt is 
again made to make a fist. The region of the break is very 
tender and usually the ends of the fragments can be felt under 
the soft parts on the back of the hand. Compound fractures of 
bones of the hand are rare. 




Fig. 25. — Dressing for fracture of the hand. 

Treatment. — The treatment for fracture of one or more of the 
bones of the palm of the hand is the application of a splint. 
The splint should be wider than the hand and should extend 
from the tips of the fingers to well above the wrist joint. A 
large, rounded pad of gauze or cotton or a handkerchief, rolled 
up like a ball should be placed in the palm to maintain the 
normal arch of the hand. The splint is applied to the palmar 
side of the hand. The extremity is then carried in a sling. 
Another dressing for fracture of the hand is shown in Fig. 25. 
A cylindrical object such as a roller bandage is placed in the 
palm of the hand, the fingers are flexed upon the cylinder and 
held by means of adhesive plaster. 



44 



TREATMENT OF EMERGENCIES 



Fracture of the Fingers. — The thumb or one of the ringers 
may be broken by direct violence. When a finger is broken, 
there is pain and tenderness and usually crepitus. There 
may be no deformity or the deformity may be marked. 

Treatment. — If there is marked deformity it is perfectly 
right and proper to pull the fragments into normal alignment. 
Then the finger should be placed upon a splint of cardboard, 
or wood. If such a splint can not be found, the whole hand 
may be put at rest on a board. 




Fig. 26. — Dressing for fracture of the finger. 



If a fracture of the finger is compound, before applying 
the splint, paint the wound with iodine and then place a 
piece of sterile gauze or clean linen over the wound. 

In emergency kits wooden tongue depressors are kept. 
They are used as splints for fractures of the fingers (see 
Fig. 26). 

Fracture of the Shoulder Blade. — Fracture of the shoulder 
blade is not only rare but is very difficult to detect. The injury 
is rare because the bone is so well protected by the muscles of 
the back and it is so movable that it usually escapes in- 
jury. When a fracture of the shoulder blade occurs, it is 
due to direct violence. There is severe pain especially on any 
movement of the shoulder. There is tenderness on pressure 
over the shoulder blade. It is difficult to elicit crepitus. 



FRACTUKKS 



45 



Treatment. — Bind the arm of the injured side to the body 
by a roller bandage and put the forearm in a sling. 

Fracture of the Ribs. — Fractures of the ribs are common. 
They are usually caused by direct violence as a blow, a kick, 
or a squeeze. Occasionally a rib is fractured by muscular 
action as during a sneezing or coughing spell, or by a sudden 
effort at lifting. A fractured rib is seldom very difficult to rec- 
ognize. There is tenderness over the site of the fracture. 




Fig. 27. — First adhesive plaster strip for dressing for fractured rib. 



Pressure on any part of the injured rib produces pain at the 
seat of fracture. Pain following a fracture of a rib is usually 
severe. The patient places one hand over the injured side, 
leans toward that side and breathes with shallow respirations. 
A deep breath increases the pain. 

A fractured rib is seldom compound externally; that is, the 
rib is seldom driven through the skin. The fracture is not 



46 TREATMENT OE EMERGENCIES 

unusually compound internally. The rib is driven inward and 
punctures the pleura and lung. The pleura is a sack which 
envelops the lung. An end of a broken rib may puncture 
the pleura alone. This is not a compound fracture. If, how- 
ever, the force is great enough, the fragment not only punc- 
tures the pleura but is driven directly into the lung. The 
fracture is then compound as there is direct communication 
with the line of fracture and the outside air. In such a 

r " " ' """ y 








i 



Fig. 28. — Completed dressing for fractured rib. 

case there is not only severe pain on breathing but the patient 
may spit up a quantity of blood. 

Treatment. — The treatment consists of putting the injured 
side of the chest at rest. This is best accomplished by the use 
of adhesive plaster. If the chest be hairy it should be shaved. 
Strips of adhesive plaster two inches in width are so applied 
as to reach from the breast bone to the spine. 

During the application of these strips of adhesive plaster 
the patient braces himself by extending the arm of the sound 
side against a wall. The arm of the injured side is raised. 



FRACTURES 



47 




Fig. 29. — Taking first turn of roller bandage of the chest for fractured 

rib. 




Fig. 30. — Roller bandage of chest for fractured rib. 



48 TREATMENT OF EMERGENCIES 

The patient is then told to empty his chest by a complete 
expiration. While the chest is empty, the first strip of the 
adhesive plaster is applied firmly over the lower area of the 
chest, Fig. 27. The patient is allowed to take a breath. He 
is again told to let out his breath and a second strip of adhe- 
sive plaster is applied covering one-half the first strip. The 
procedure is repeated until the adhesive strips extend from 
below the broken rib to the margin of the arm pit (Fig. 28). 
If adhesive plaster is not available, immobilization of the 
chest may be partly accomplished by means of a roller bandage 




Fig. 31. — Binder of chest. 

three or four inches wide applied to the chest, or by a binder. 
Each time the patient lets his breath out a turn of the bandage 
is made around the chest (Fig. 29). Fig. 30 shows the dress- 
ing accomplished by means of a roller bandage. Fig. 31 shows 
the binder of the chest. A roller bandage or a binder of the 
chest, applied for fracture of one or more ribs, can not be 
left in place for any great length of time as the sound side of 
the chest is compressed as well as the injured side and 
breathing is difficult. 



FRACTURES 



49 



Fractures of the Spine. — A fracture of the spine is a very- 
serious injury and one which can only be certainly recognized 
by a surgeon. In public opinion any man who can not move 




Fig. 32. — The spine sawed in sagittal section. Fracture of the seventh 
cervical vertebra, with dislocation forward of the upper fragment. Frac- 
ture of the arch of the sixth and of the spine of the seventh vertebra. 
Total crush of the cord. The discoloration of the cord from blood shows 
plainly in the plate (Thomas). 

his legs after an injury is supposed to have a "broken back." 
This rule is true in many cases, but not in all. Sometimes we 
find a person can not move the legs, though no fracture of 

4 



50 TREATMENT OF EMERGENCIES 

the spine exists. Some cases with fracture of the spine can 
move the legs. The subject of broken back is considered in 
this book not to discuss treatment, which belongs entirely to 
the surgeon, but to illustrate the method of lifting the patient 
and to describe the proper transportation of such a case. It 
is imperative that a patient who has suffered a severe back 
injury be placed upon a stretcher in the proper manner. The 
spine may be fractured and yet there may be no paralysis. 
If the patient is lifted roughly or carelessly the broken bones 
may lacerate the spinal cord and cause a paralysis which may 
be permanent or which may even be fatal (Fig. 32). The 




Fig. 33. — First step for correct method of lifting an injured person. 

transportation of a person suffering from an injury to the 
spine is one of the most important subjects of first aid. If a 
man falls and receives a severe blow to the spine do not at- 
tempt to move him nor to turn him on his back unless of 
course he is in a dangerous position as is a fireman, when 
under a swaying wall or when exposed to smoke or a poison- 
ous vapor. Bring the stretcher or a board or a ladder and 
place it alongside of the victim. 

It requires at least three people to properly and safely lift 
the patient to a stretcher. 

Three men kneel alongside of the patient; each one kneels 



FRACTURES 



51 



upon the knee nearest to the patient's head. If lifting from 
the right side of the patient each kneels on the left knee, and 
if lifting from the left side of the patient each kneels on the 
right knee. 

They then put their arms under the patient. The first 
man places his arms under the patient's neck and shoulders; 
the second man places his arms under the small of the back 
and buttocks, and the third puts his arms under the thighs 
and legs (Fig. 33). 




Fig. 34. — Second step for lifting an injured person. 



At a given command they raise the patient in unison and 
vest the patient upon their knees as shown in Fig. 34. 

The stretcher is then placed in front of them and at a second 
command the patient is gently placed upon the stretcher. 

If, however, the patient must be carried for a distance to 
reach a stretcher, the bearers after lifting the patient to their 
knees at a given command all arise to the standing posture 
(Fig. 35). 

This is a most important method of transportation to 
learn, as it is used not only in injuries to the back, the pelvis 



52 TREATMENT OF EMERGENCIES 

and in fractures of the thigh, but is also used in all cases of 
severe injuries accompanied by shock. 

Fracture of the Pelvis. — This injury is a very severe one 
but is rare. It is mentioned here for the same reason that 
fracture of the spine is mentioned, namely, because of the 
care which must be practised in the transportation of the. 
victim. The fracture is often very difficult to recognize, and 



Fig. 35. — Third step. Correct method for lifting an injured man. 

may not be evident without the use of the X-ray. The 
injury is frequently accompanied by internal injury, such as 
rupture of the bladder, etc. Care must be taken to treat the 
accompanying shock (see page 109), and the patient must be 
lifted to a stretcher as described on page 50. 

Fracture of the Thigh. — There is one bone of the thigh. 
This bone is called the femur. The femur extends from the 
hip to the knee. This bone is frequently fractured in street 



FRACTURES 



53 



accidents and firemen not infrequently sustain such a frac- 
ture following falls from roofs, ladders, etc. It is a serious 
injury and is always accompanied by severe shock. Pain is 
severe. Tenderness, is acute; there is loss of function of the 
leg. The patient is unable to stand. Never try to elicit 




Fig. 36. — Relation of vein, artery, and nerve to thigh hone. 

crepitus or undue mobility, as by so doing vessels and nerves 
which lie in close proximity to the fractured bone may be 
seriously injured. The jagged ends of the fracture may sever 
the vessels, and as a result amputation may be necessary. 

Fig. 36 shows the close relation of the thigh bone to the 
vein, artery, and nerve of the leg. 




Fig. 37. — Shows how injury to vein, artery, or nerve may occur fol- 
lowing fracture of thigh. 

Fig. 37 shows how injury may occur to the vein, artery, 
or nerve of the leg following fracture of the thigh. 

Treatment. — There is no bone in the bod}- which demands 
more attention when fractured than the bone of the thigh. 
As stated above, the main artery, vein, and nerve to the leg 



54 



TREATMENT OF EMERGENCIES 



are in close proximity to the bone, just above the knee. In 
fact in the bend of the knee the artery and nerve lie directly 
against the bone. 




Fig. 38. — Use of gun as splint for fracture of thigh or leg. 




Fig. 39. — Incorrect way to lift an injured man. 

If a fracture of the femur exists and a patient is lifted as in 
Fig. 39 without a splint and without the proper precaution, 
grievous injury may be inflicted upon the artery, vein, nerves 
and other soft parts. A simple fracture could be made com- 



FRACTURES 55 

pound. Subsequent amputation might be demanded because 
of careless lifting. 

The first step is to fix the thigh securely on a splint. This 
splint should reach from the arm pit to below the foot. In 
military practice a gun is used for such a splint. The stock 




Fig. 40. — Broom used as splint for fracture of the thigh. 



of the gun is placed in the arm pit and the barrel of the gun is 
laid along the outer side of the thigh and leg and held by 
strips of bandage as shown in Fig. 38. In civil life a board 
or a broom may be used. 

The splint is applied as in Fig. 40. It is well if possible to 



Jft/ Mi 




■*°-~ ~^ 


^■CvV 





Fig. 41.— Board carried on Philadelphia fire trucks used as splint 
for fracture of the thigh. 

apply a short splint on the inner side of the leg, reaching from 
the crotch to the foot. 

Often on the fire ground it is hard to find a suitable splint 
for a fracture of the thigh. It is frequently necessary to 
remove a fireman quickly. It is well in such a case to tie the 



56 TREATMENT OF EMERGENCIES 

injured thigh and leg to the sound thigh and leg, then lift 
the fireman, place him upon a ten-foot scaling ladder, which 
is always accessible and convey him to a place of safety, when 
a broom or some other splint may be obtained. A board splint 
for such a fracture is now carried on each Philadelphia fire 
truck (Fig. 41). 

A hoseman sustained a fracture of the thigh at a fire in a 
Philadelphia theater. Partly because of rough handling at 
the time, the nerves of his leg were injured, and for several 
years he has suffered from inflammation of those nerves. 

A fracture of the femur is seldom compound as there are 
heavy muscles and thick tissues around the bone. 

When the fracture is compound after hemorrhage is con- 
trolled, the wound is painted with iodine and a sterile dressing 
is placed over the wound before applying the splint. 

If a fireman sustains a severe injury to the thigh or leg, 
never attempt to pull the boots and trousers off but cut them 
off with a pair of heavy bandage scissors. Such scissors 
should be part of the emergency equipment of every fire 
truck. 

Fractures of the Knee Cap. — Fractures of the knee cap are 
usually due to muscular action, seldom to a direct blow or 
fall upon the knee. 

Such fractures occur during falls but usually the bone is 
broken before the knee touches the ground. In the accom- 
panying diagram (Fig. 42) it may be seen that when the knee 
is flexed the knee cap sets upon the lower end of the thigh bone, 
which acts as a fulcrum. The upper half of the knee cap is a 
lever. If, while the knee is flexed, the toe or the foot is caught, 
the heavy thigh muscles pull on the knee cap from above and 
the strong ligament below the knee cap holds it firmly from 
riding upward; therefore, great strain is brought to bear upon 
the knee cap and the bone separates transversely or near the 
midline (Fig. 42). When such an injury has been sustained, 
the patient usually falls to the ground. There is early and 
great swelling of the knee. Pain is severe, and as the frag- 
ments are usually separated, a space or gutter can be felt 
between them. The victim can stand and can walk back- 
ward, but can not walk forward unless the leg and thigh are 



FRACTURES 



57 




Fig. 42. — Showing how fracture of the kneecap occur-. 




Fig. 43. — Fracture of the patella, showing wide separation of the 
fragments (Da Costa). 



58 TREATMENT OF EMERGENCIES 

kept in a straight line. Most victims of such an injury think 
they can not walk, this apparent disability being due to pain 
in making the attempt. Fig. 43 is an X-ray picture of a 
fractured knee cap. 

Treatment. — The emergency treatment of such an injury 
is to fully extend the leg. A splint reaching from the lower 
part of the calf of the leg to the middle of the thigh should 
be placed on back of the leg. If adhesive plaster can be had, 
a strip one and one-half inches or two inches wide should be 
placed above the upper fragment and the adhesive plaster 
drawn diagonally downward and attached to the splint at a 
lower level. The second piece of adhesive plaster is put below 




Fig. 44. — Dressing for fracture of the knee cap prior to the applica- 
tion of the roller bandage. Illustration shows method of applying 
adhesive plaster strips. 

the lower fragment and applied diagonally upward and 
attached to the splint at a higher level. A third piece of 
adhesive plaster is placed transversly across the fragments 
(Fig. 44). A roller bandage is then applied. If no adhesive 
plaster is available, apply the splint and hold the splint in 
place by means of a roller bandage. 

Fracture of the Leg. — The leg is that part of the lower ex- 
tremity between the knee joint and the ankle. The leg con- 
tains two bones, which are called the tibia and the fibula. 
The tibia is the larger bone and one which constitutes most 
of the support. Either or both bones may be broken. 
When both bones are broken or when the larger of the bones, 
the tibia, is broken, the patient is at once incapacitated. The 



FRACTURES 



50 



smaller bone (the fibula), however, may be broken and the 
patient may still be able to walk. When the smaller bone is 
broken near the ankle, it is often hard to distinguish the condi- 
tion from a severe sprain of the ankle. For this reason great 
care must be taken in treating by first aid methods a suspected 




Fig. 45. — Horse blanket used as splint for lower leg. 

sprain of the ankle, as such an injury is often a fracture. A 
fracture of the leg is a common injury. If the larger of the 
two bones is broken, the fracture is often compound. Such a 
fracture carries with it decided danger and it depends to a 
large extent upon the first aid treatment whether or not the 




Fig. 46. — Pillow used as splint for lower leg. 

ultimate result will be good or poor. If the injur}' is roughly 
or carelessly handled, there may be absolute destruction of 
the surrounding tissues and permanent deformity may ensue. 
Occasionally, this destruction is so great that amputation 
must -be subsequently performed. 



60 



TREATMENT OF EMERGENCIES 



Treatment. — A simple fracture must be treated by the appli- 
cation of a splint. There are many different appliances which 
may be used as temporary splints. A folded blanket (Fig. 45) 
or a pillow may be used as in Fig. 46. This is a very common 
method of treatment on the fire ground or in street accident 
cases. An umbrella or a cane may be used as in Fig. 47. One 




Fig. 47. — Use of umbrella and- cane as splint for fracture of the leg. 

method of splinting the leg which has been employed is to stuff 
the trousers with straw or hay. I have never used this method 
and do not recommend it. If no other splint is available, 
the sound leg can be used as a splint and the injured leg may 
be bandaged to the sound leg as in Fig. 48. The board splint 
shown in Fig. 49 is carried on the Philadelphia fire trucks. 




Fig. 48. — Use of sound leg as splint for fracture of the other leg. 
Note that the feet are tied together to prevent eversion of the injured 
leg. 

The same care must be used in lifting the patient for such an 
injury as is described on page 50. If the fracture is com- 
pound, a sterile dressing must be placed over the wound after 
painting the wound with iodine. A bandage is then applied 
to hold the dressing in place before the splint is applied. 



FRACTURES 



61 



Fractures of the Foot and Toes. — The bones of the foot and 
toes are usually fractured by direct violence as by the dropping 




FlG. 49. — Hoard used as splint for lower log. Noto foot tied together 
to prevenl eversion of fool of injured l<'tz. 

of a heavy weight upon them. There is usually marked 
impairment of function. The patient is unable to walk or 




Fig. 50. — Fracture of bones of foot (Da Costa). 

place any weight upon the foot without great pain. There is 
pain, tenderness and swelling. 



62 TREATMENT OF EMERGENCIES 

Treatment. — The foot should be put at rest and a splint be 
placed upon the sole of the foot. The lid of a cigar box may 
be used as a splint. Care must be taken, however, to pad the 
under surface of the arch of the foot so that the arch may be 
maintained. If no splint can be found, the foot and ankle 
should be firmly but not tightly bandaged. The patient must 
not put the foot to the ground. 



CHAPTER II 
CONTUSIONS AND WOUNDS 

A contusion is a bruise. It is caused by a blunt force, such 
as a kick or a punch. There is no wound of the skin. The 
condition is a subcutaneous laceration. The symptoms of a 
contusion are pain, swelling, heat, discoloration and loss of 
function of the part. These symptoms vary according to 
the severity of the blow and the part of the body upon which 
the blow is inflicted. The swelling gradually subsides, the 
pain lessens and function is restored. The discoloration which 
is first red, changes to a blue-black, then to violet, to green, 
and then fading into a brown and finally yellow. The early 
red discoloration is due to inflammation, the later color changes 
are due to the color changes in the blood, which flowed from 
injured vessels into tissues. Such blood slowly works its way 
into the skin. 

The discoloration from the ruptured blood vessels may 
appear during the first few hours after the application of the 
force, or it may not appear for many hours, for a day or sev- 
eral days. The time of its appearance depending upon the 
depth in the tissues of the injured blood vessels and the vas- 
cularity of the part. 

As an example, a contusion of the tissues of the lids of the 
eye results in a black eye within a few hours because the blood 
of the ruptured vessels rapidly finds its way to the skin. 

In a contusion of the thigh or buttocks the skin may not 
become discolored black and blue for days, as the blood ves- 
sels are situated deeply in the tissues and very dense fascia 
covers the muscles. A contusion may involve rupture of a 
large blood vessel. This causes the formation of a circum- 
scribed collection of blood. The fluid can be detected by the 
sense of fluctuation imparted to the examining fingers; it is 

63 



64 TREATMENT OF EMERGENCIES 

circumscribed by condensed tissues and soon by a blood clot 
which feels firm to the touch; the liquid center and the hard 
edges are characteristic. Such a circumscribed collection of 
blood is called a hematoma. 

Treatment. — A contusion, if seen soon after the infliction 
of the injury, is treated by rest, elevation of the part and 
local applications of an evaporating lotion. 

If an extremity be severely bruised, it should be put at rest 
on a splint. Only by means of a splint can absolute rest be 
obtained. When, possible, the part should be elevated. A 
contused extremity can be elevated by placing itr on. one or 
two pillows. It is a common experience that an injured part 
throbs and aches more when allowed to hang down than when 
it is elevated, because the venous return is favored by eleva- 
tion, and congestion of the part is thus relieved. The appli- 
cation of cold by an evaporating lotion tends to stop bleeding 
into the tissues and reduce the inflammation by producing 
cold. Lead water and laudanum is a favorite household 
remedy. To properly apply this solution, cloths should be 
soaked in the solution and laid on the injured part. These 
cloths should not be covered with wax paper, nor should they 
be bandaged, but should be left uncovered so as to allow free 
and rapid evaporation. Lead water is the constituent which 
causes the rapid evaporation. It was long supposed that 
laudanum was absorbed by the tissues and thus relieved pain, 
a theory which is untrue. 

Cold relieves pain by lessening the amount of blood sent to 
a part and by thus abating tension. 

Another solution useful for the treatment of contusions is 
a saturated solution of epsom salts. Cloths wrung out in the 
solution of epsom salts are placed upon the contusions. An 
ice bag may be used to apply cold, but usually the weight of 
the bag over the injured area is painful, and the cold is often 
too excessive. If the tissues have been so badly injured that 
their vitality is dangerously lowered, the application of the 
ice bag may cause gangrene. Cold is to be used only during 
the very earliest hours after the injury. When used later it 
always does harm. When cold is abandoned, the part should 
be bandaged in order to give equal compression to the vessels 



CONTUSIONS AND WOUNDS 65 

and tissues and heat in the form of a hot water bag should be 
used. 

After the acute inflammatory process has subsided, the part 
should be dressed with a soothing ointment such as ichthyol 
(25 per cent.) or an ointment of belladonna and mercury, and 
a firm bandage applied. At the present time ichthyol is diffi- 
cult and expensive to obtain. An ointment of iserol (25 per 
cent.) is an excellent substitute. Massage tends to restore 
the parts to their normal condition. It must not be used 
early after a severe contusion as it may cause embolism. 

If a blood tumor or hematoma has been formed, it should 
not be opened as it is a favorable soil for infection. The 
blood in the tumor should be allowed to be absorbed. If an 
abscess forms, it should be promptly incised by a physician. 

CONTUSIONS OF SPECIAL PARTS 

Contusions are common about the head and not unusually 
cause a pronounced swelling or lump. Such an injury must 
always be regarded with anxiety and a physician's advice 
should be sought. A layman can not diagnose such a contu- 
sion from a fracture of the skull. Until the arrival of a 
physician the patient should be kept in a reclining position. 
The head should be slightly elevated, and cold applications, 
such as an ice bag, or compress saturated with cold witch 
hazel or cold boric acid solution should be applied over the 
swelling. Whiskey or brandy should never be given to one 
who has suffered a head injury as all forms of alcohol tend 
to cause excitement and perhaps congestion of the brain. 

Contusions of the Eyelids and Surrounding Tissues. — 
A contusion of the eyelids or tissues surrounding the eye 
commonly known as a "black eye" is a very frequent injury. 
Occasionally the swelling is so great that the eye is completely 
closed. The upper and lower eyelids and the surrounding 
tissues become black and blue. Cold applications of a solu- 
tion of boric acid will reduce the swelling. A very successful 
method of treatment to such an injury is as follows: Take 
several pieces of lint, the diameter of each being that of an 
orange ; place these pieces of lint on a small cake of ice. When 

6 



66 TREATMENT OF EMERGENCIES 

a piece of lint has become cold, place it over the contused 
eye. After this piece of lint has been on the eye for five or 
ten minutes, it will become warm. It is then removed, is 
placed again upon the ice, and a fresh piece of lint is taken 
from the ice and placed upon the eye. The eye itself should 
be washed with boric acid solution (see page 200) every two or 
three hours. After the inflammation has subsided, the dis- 
appearance of the swelling and of the black and blue discolo- 
ration can be greatly hastened by painting the discolored 
parts with contractile collodion. 

The very greatest care, however, should be used- in painting 
the eyelids with collodion. Collodion contains ether and if 
any of the fluid comes into contact with the eyeball it will 
cause a painful and serious inflammation. Collodion may be 
applied to the discolored lids by means of a camel's-hair 
brush. 

Contusion of the Chest. — Severe contusion of the chest is 
followed by shock. It may be accompanied by fracture of a 
rib, or ribs (see page 45). If there is severe pain on breathing 
or if there is spitting of blood, a fractured rib should be sus- 
pected. Even though no fracture exists, if the contusion is 
severe and breathing causes pain, strapping the chest will give 
great relief (see page 46). The patient must, of course, be 
put to bed. 

Contusion of the Abdomen. — A contusion of the abdomen 
is often accompanied by very grave internal injury. The 
result is certain to be serious, if an internal injury is not 
promptly recognized. Any severe contusion of the abdomen 
is complicated by profound shock. Serious injury to the 
internal organs may be present after a contusion of the ab- 
domen when there is absolutely no sign of external violence 
upon the skin. The stomach, the intestines, the bladder or 
any of the abdominal organs may be ruptured and yet there 
may be no evidence of bruise, abrasion or laceration of the 
skin of the abdomen. 

A case to illustrate this point is as follows: A boy while 
playing in the street, was run over by a wagon. One wheel 
of the wagon passed over his abdomen. There was no sign 
of any bruise nor laceration of the skin of the abdomen or the 



CONTUSIONS AND WOUNDS 67 

back. It was found, however, at operation that the child's 
intestines were completely severed. Such cases are not 
infrequent. 

Therefore, any case of contusion of the abdomen should be 
at once examined by a physician. A contusion of the pit of 
the stomach is commonly known as a blow to the "solar 
plexus." The solar plexus is a network of nerves which lie 
just behind the stomach. A blow over the stomach is trans- 
mitted to this network of nerves and causes severe shock, 
usually rendering a person unconscious. It may produce 
instant death. Following a contusion of the abdomen, the 
victim may vomit. The vomitus may or may not contain 
blood. 

Treatment. — The treatment of a contusion of the abdomen 
is first of all the treatment for shock (see page 109). 

The case should be seen by a physician as early as possible. 

Contusions of the Spine. — Any severe injury to the back 
must be regarded with anxiety as there may possibly be a 
fracture or dislocation of one of the vertebra?. A victim of 
a back injury should be lifted and transported as described 
on page 50, and should be examined at once by a physician. 

WOUNDS 

Wounds are divided into seven main groups: contused, 
lacerated, incised, punctured, stab, poisonous and gun shot. 

CONTUSED AND LACERATED WOUNDS 

A contused wound is caused by a blow with a blunt instru- 
ment in which the surface of the skin is ruptured, crushed or 
split. The wound is jagged and the tissues surrounding the 
wound are contused. There is often confusion concerning 
the difference between a contusion and a contused wound. 
The difference is well illustrated by the following examples. 
If a man is struck on the head by a blackjack, and the parts 
become swollen, tender, painful and discolored, but there is 
no open wound of the scalp, the injury is a contusion of the 
scalp. If, however, the blow by a blackjack not only caused 



68 



TREATMENT OF EMERGENCIES 



a contusion of the tissues, but also an actual open wound, 
the injury is a contused wound (Fig. 51). 

A kick upon the snin bone which causes the skin over the 
bone to split is another example of a contused wound. 

A lacerated wound is caused by the tearing apart of the 
tissues. Such a wound is inflicted, for instance, if a hook is 
dragged through the tissues. The lacerated wound is jagged 
and is accompanied by more or less contusion of the surround- 
ing parts. Hemorrhage from a lacerated wound is seldom 
severe as torn blood vessels are not apt to bleed violently, 




Fig. 51. — A contused wound of the scalp resulting from a blow with a 

"blackjack." 

the blood clotting quickly in the jagged and irregular tissue 
gaps. When a vessel is torn completely across, the inner 
coat is usually able to contract and retract while the outer 
coat falls across the mouth of the vessel, forming a barrier 
which arrests blood and favors the formation of a clot. If a 
blood vessel is only partially torn, the hemorrhage is certain 
to be more profuse as the inner coat of the vessel can not 
contract and retract. 

Treatment of Contused Wounds and Lacerated Wounds. — 
During recent years the first aid treatment of open wounds 
has undergone a radical change. The text of the treatment of 
such wounds was formerly, stop the bleeding, cleanse the 



CONTUSIONS AND WOUNDS 



69 



wound and put the part at rest. The text of the first aid 
treatment at the present time is stop the bleeding, keep the 
wound clean, put the part at rest and react the patient from 
shock. The modification of the treatment of lacerated and 
contused wounds is due to the fact that a wound can not be 
satisfactorily cleansed unless the operator's hands as well as 
his instruments, solutions and dressings are surgically clean. 
A case to illustrate this is as follows: A fireman while at a 




Fig. 52. — Ampules of iodine. 

fire receives a lacerated wound of the hand. It was formerly 
our policy after hemorrhage was stopped to attempt to cleanse 
the wound with hydrogen peroxide and then to apply a 
dressing of gauze containing bichloride of mercury. When 
we consider, however, that the fire surgeon's hands are not 
clean, that the parts surrounding the wound can not be 
thoroughly cleansed on fire ground and that the solutions can 
not be kept clean, it was decided that as much harm as good 



70 



TREATMENT OF EMERGENCIES 



resulted from such attempts at treatment and much useless 
delay resulted. Now the treatment of such a case is to arrest 
hemorrhage, paint the wound with iodine from one of the am- 
pules shown in Fig. 52, and then to apply a dressing from a first 
aid package shown in Fig. 53. The iodine is contained in a glass 
ampule. One end of the ampule is broken. The iodine 
saturates the gauze which is attached to the ampule and is 
then painted over the wound. The dressing shown in Fig. 
53 is part of the first aid package now in use in the United 
States Army. The package may be put up either in a tin 




Fig. 53. — Contents of first aid package. 

box or a cardboard box. It contains a compress of sterile 
gauze to which a bandage is attached, a triangular bandage 
and two safety pins. The best package is the one which is 
contained in a sealed tin box. The sterile gauze compress is 
taken from the box, care being used not to touch the inside 
of the compress. The compress is opened and placed upon 
the wound (see Fig. 54), after the wound has been disinfected 
with iodine contained in one of the ampules. The compress 
may be applied to the head as in Fig. 55. 

The bandage is then applied to hold the compress in place. 



CONTUSIONS AND. WOUNDS 71 

The part is then put at rest by means of a sling or a splint. 
The case is sent to a hospital where the wound can be satis- 
factorily cleansed and a permanent dressing applied. Al- 
though such first aid packages are handy and are compact, 
yet of course they are not essential, as a piece of sterile gauze 
from an ordinary package may be applied, its application 
being followed by a bandage. 




Fig. 54. — Application of iodine from ampule and application of gauze 
compress to wound. 

Occasions sometimes arise, for example camping expedi- 
tions, when no such temporary first aid dressing is at hand and 
when the case can not receive treatment at a hospital or from 
a physician for a number of hours, or perhaps days. The 
procedure in such a case must necessarily be different. It is 
now imperative to cleanse the wound after checking hemor- 
rhage. The hands and arms of the operator should be thor- 
oughly washed with soap and hot water (using a nail brush) 
and then rinsed with alcohol. The area around the wound, 
if it be hairy, should be shaved. While a piece of gauze is 



72 



TREATMENT OF EMERGENCIES 



held directly over the wound, the parts surrounding the wound 
are cleansed with soap and warm water. It is best to use 
tincture of green soap, which should be a constituent of a 
first aid kit, and it is necessary that all water used in or around 
the wound should have been boiled for at least ten minutes. 
Never use unboiled water. After cleansing the surrounding 
parts, the wound is washed out with hydrogen peroxide, the 




Fig. 55. — Compress from first aid package applied to head. 

strength of which is 1 part of peroxide to 3 parts of boiled 
water. All foreign bodies such as dirt, broken glass, etc., 
should be removed from the wound. None but a physician 
should ever attempt to cut away damaged parts or damaged 
tissues, as such parts, although apparently hopelessly damaged, 
may perhaps be saved by proper care. When sponging the 
wound, great gentleness should be used as rough handling 
induces pain, bleeding and shock. Irrigation of the wound 



CONTUSIONS AND WOUNDS 73 

is preferable to wiping or sponging it. The peroxide should 
be washed from the wound by sterile water. The wound is 
then ready to dress. A piece of gauze wet with an antiseptic 
solution is now placed over the wound, a piece of wax paper 
is used to cover the gauze and a suitable bandage is applied. 
One of a number of antiseptics may be used ; that is, bichloride 
of mercury in the strength of 1 to 4000; carbolic acid, 1 part 
to water 80 parts; alcohol 70 per cent.; creolin 1 per cent.; 
lysol 1 per cent.; or boric acid solution in concentrated 
strength. Iodine, when used, should be 2 to 4 per cent. 
Great care must be used in the application of carbolic acid 
dressings. The use of too strong a solution or the use of a 
solution of carbolic acid for a number of hours might cause 
sloughing or even gangrene of the part to which it is applied. 
The danger of gangrene from a carbolic acid dressing is greater 
if used on the fingers or on the toes than if used on the trunk 
as the tissues of the trunk receive better nourishmenl than 
the tissues of the fingers or toes. A watery solution of 
carbolic acid is more apt to cause gangrene than a solution of 
carbolic acid in glycerine, because the water of the first 
solution evaporates and leaves the concentrated carbolic 
acid over the area. Carbolized dressing should be changed 
daily to be sure that nothing is going wrong with the parts. 

In compound fractures, the wound may be thoroughly 
swabbed out with a 2 to 4 per cent, solution of iodine. 

The Dakin-Carrel antiseptic solution which is being used 
so extensively for the treatment of wounds in the present 
war can not be used by the layman. To use the solution 
successfully one must be thoroughly familiar with the special 
technique. 

Sutures should never be placed in a wound except by a 
physician. A wound is never sutured if asepsis is not assured. 
In case of doubt, it is far better to pack the wound with 
iodoform gauze or to apply one of the antiseptic dressings 
above described. It is better not to wash a wound at all than 
to attempt to wash it with unboiled water. 

It should be remembered that all wounds which contain 
street dirt, and wounds sustained by persons in and about 
stables, are especially prone to infection by tetanus or lock-jaw. 



74 TREATMENT OF EMERGENCIES 

Any victim receiving such a wound should at once receive 
an immunizing dose of tetanus antitoxin (see page 83). 

Laceration of Special Parts. — Laceration of the scalp is 
common. Such an injury must always be regarded with 
anxiety lest it be associated with a fracture of the skull or an 
intracranial injury. Lacerations of the scalp usually bleed 
profusely because there are many blood vessels running 
through the scalp, and because the fibrous character of the 
tissue in which the vessels lie will not permit them to con- 
tract or retract. 

If the patient can be readily sent to a hospital, after check- 
ing the hemorrhage, apply a compress of clean gauze over the 
wound and use a bandage to hold the compress in place. 

The triangular bandage shown on page 226 may be used, or 
a roller bandage may be applied, as shown on page 234. 

If it is impossible to obtain a physician at once or to reach 
a hospital promptly, a more permanent dressing must be 
applied. The operator should carefully wash his hands. The 
hair around the laceration should be shaved. Any foreign 
bodies should be removed from the wound. The wound is 
then treated as directed on page 71. Care must be taken 
in the use of antiseptics about the scalp to see to it that the 
drug does not run down into the eyes. 

Often the whole scalp is grimy with dirt and the hair is 
matted. In such a case rub the scalp well with olive oil and 
scrub out the olive oil with soap and water. 

The soap and water will remove the oil and with it the dirt. 

Lacerations About the Face. — Lacerations of the face usually 
bleed freely, especially those about the mouth. Unless a 
physician can be promptly reached, it is well to draw the 
edges of the lacerations together with adhesive plaster to 
try to prevent a wide and ugly scar. The physician sews up 
such wounds with very fine stitches. The blood supply of 
the face is so free that the lacerated wounds may be sutured 
without hesitation. 

Lacerations About the Lips and Gums. — In lacerations about 
the lips or gums the mouth should be washed at frequent 
intervals with peroxide of hydrogen or with a mild antiseptic 



CONTUSIONS AND WOUNDS 



75 



solution. A wound of the lip, even on the inside of the lip, 
should be sutured. 

Lacerations of the Knuckles Caused by Cuts from Teeth. — 
Lacerations of the knuckles caused by hitting a person in the 




Fig. 56.-— Result of an infection following striking a prisoner and 
receiving laceration by tooth. 




Fig. 57. — Lacerated wound of hand with inflammation — result of 
striking against tooth 

mouth and being cut by the teeth always become badly 
infected. 

The injury is very common among policemen. Fig. 56 
shows the hand of a policeman who struck in the mouth a 



76 



TREATMENT OF EMERGENCIES 



prisoner who was resisting arrest. The officer received a 
small laceration from one of the prisoner's teeth and, in spite 
of radical treatment, infection became very severe and ampu- 
tation of one finger was necessary. Fig. 57 shows another 
laceration from striking a prisoner on a tooth and receiving 
a cut on the knuckle. This officer developed a serious 
inflammation of his hand and arm. Syphilis may be so caused, 
a chancre developing at the site of the wound upon the 
knuckle. 

Such wounds caused by teeth should be disinfected with 
pure carbolic acid. A piece of cotton is placed upon an appli- 




Fig. 58. — Infection of thumb following a "tooth cut." 



cator. The tissues about the wound are moistened with 
alcohol. The cotton is soaked with pure carbolic acid and 
the wound is swabbed. The surrounding skin is wiped afresh 
with alcohol to keep it from being burned by the carbolic acid. 

The wound is then drained with a piece of rubber tissue and 
an antiseptic dressing is applied. The part should be placed 
upon a splint. Never place a suture in such a wound. 

Avulsion of the Scalp. — A woman working in a mill may get 
her hair caught in the belt or piece of machinery and if this 
occurs the scalp will possibly be wholly or partially torn off. 
The accident makes a ghastly wound (Fig. 59). It is always 



CONTUSIONS AND WOUNDS 77 

accompanied by great shock. When possible, the scalp after 
being rendered surgically clean should be replaced upon the 
head as the surgeon may be able to save part or all of it. If 
the scalp can not be replaced, it should be saved for the surgeon 
who is to treat the case, as pieces of the scalp may be used for 
skin grafting of the part. 




Fig. 59. — Avulsion of the scalp (Fowler's Surgery). 

Avulsion of an Extremity. — A finger, a hand, an arm, a toe 
or a leg may be torn from the body, if the extremity should be 
caught in machinery. Hemorrhage is usually slight but the 
shock is always profound. The wound is treated as a lacerated 
wound. 

INCISED WOUNDS 

An incised wound is inflicted by a sharp cutting instrument , 
such as a razor, or a cleaver. The edges of such a wound 
gap (Fig. 60). The tissues around the wound are not devi- 
talized, therefore, infection is not as apt to follow an incised 
wound as it is to follow a lacerated wound. Hemorrhage is 
free and often profuse. 



78 



TREATMENT OF EMERGENCIES 



Treatment. — After the hemorrhage has been checked, if it 
is known that a physician will soon be at hand, it is well to 
apply a clean dressing, and allow the physician to use his own 
judgment concerning the cleansing and the suturing the wound. 
Such a wound is not very prone to infection and seldom needs 
disinfection by a strong antiseptic solution, in fact the wound 
never needs cleansing unless the instrument which caused it 
is grossly infected, for instance unless the instrument was a 
butcher's cleaver or a post-mortem knife. Often if an irritant 
antiseptic solution is used or if the parts are handled roughly, 






Fig. 60. — Incised wound (Bryan). 

a wound which would otherwise remain clean may become 
infected because irritation lowers the vital resistance of the 
tissues. Furthermore, irritation increases the flow of wound 
fluid and makes drainage necessary. The edges of the wound 
may be drawn together by means of a piece of zinc oxide adhes- 
ive plaster, and clean dressings should be applied. 

Incised Wounds of Special Parts. — Incised Wounds of the 
Face. — Such wounds are often caused by razors. The wound 
bleeds freely. The hemorrhage can usually be checked by 
holding a piece of clean gauze upon the wound and making 



CONTUSIONS AND WOUNDS 79 

firm pressure with a finger. After the bleeding is checked, 
a piece of clean gauze should be placed over the wound and 
held in place by a piece of zinc oxide adhesive plaster. Such 
wounds seldom require washing with any antiseptic. It is 
not wise to seal such a wound up with collodion, as, if by any 
chance it should be infected, the infection would be sealed in. 

Cut Throat. — A cut throat may be either suicidal, homicidal 
or accidental. In a large majority of suicidal cases the weapon 
used is a razor. Such a wound usually starts under the left 
ear (in a right-handed person). In most cases the great ves- 
sels are not severed because as the man starts to cut he in- 
voluntarily throws the head back which takes the great vessels 
back and often out of the course of the weapon. In many 
cases after cutting as far as the external jugular vein, the man's 
courage fails because of pain and he ceases to enlarge the 
wound. If, however, he should be more desperate, the carotid 
artery and the internal jugular vein may be cut. The muscles 
are extensively severed, and often the windpipe is incised or 
even cut across. If the carotid artery is cut and a surgeon is 
not at hand, the wound is invariably fatal, as it takes but a 
few minutes to bleed to death from a wound of this large 
vessel. In very severe cases, not only are the vessels of one side 
and the windpipe severed, but also the gullet ma}- be cut. 
In case of suicide it is improbable that the great vessels on 
both sides can be divided. A cut throat is a ghastly sight. 
The hemorrhage is enormous and if the windpipe is cut, eacli 
time the victim breathes blood is sucked in and blown out 
with a horrible gurgling noise. 

If the throat has been cut in attempted suicide, the wound 
may be only in front, cutting the windpipe but missing the 
great vessels. If the throat has been cut with homicide inten- 
tion, the great vessels are usually cut and the wound is apt 
to be extensive, sometimes running from ear to ear. Imme- 
diate death may be caused from hemorrhage or from suffoca- 
tion by blood entering the windpipe. 

Treatment. — If only the external jugular vein has been cut, 
the patient may recover. If the carotid artery, or internal 
jugular vein, is severed, the hemorrhage is usually fatal within 
a few minutes. Do not stop to cleanse the hands but at once 



80 TREATMENT OF EMERGENCIES 

try to grasp the bleeding vessel with the fingers. If the vessel 
can not be grasped, plunge one or more of the fingers into the 
wound, and make firm pressure over the line of the vessels of 
the neck against the cervical vertebrae (see page 113). If the 
windpipe has been cut and blood runs into it, lower the head 
and wipe the blood out so that it will not clot in the windpipe 
and cause strangulation. If successful in checking the hemor- 
rhage, do not relax your hold on the vessel until the patient has 
reached a hospital or until a physician arrives and even then do 
not relax it until some better means such as a hemostatic forceps 
is ready to grasp the bleeding vessel. The physician, after 
tying the bleeding vessels, usually sews up the structures layer 
by layer and after the dressing is applied, a bandage holds the 
head fixed or bent forward on to the chest so that all the injured 
structures are relaxed. The physician in some cases is not 
able to sew the wound up but after hemorrhage has been 
stopped performs tracheotomy. It is not often that a woman 
attempts suicide by cutting the throat. It is essentially a man 
injury in suicide cases. 

PUNCTURED WOUNDS 

A punctured wound is made by a pointed object such as a 
nail, a needle or a splinter. The depth of the wound is greater 
than its width. Any foreign body such as dirt, rust, etc., 
which has been carried into the tissues, tends to remain in 
the depths of the wound. The tissues in the track of the 
wound contract to different degrees and the mouth of the 
wound closes after the instrument which caused the damage 
has been withdrawn, hence the drainage of infected materials 
can not take place. Hemorrhage from such a wound is usu- 
ally slight as the blood vessels are apt to be pushed ahead of 
or to one side of the penetrating object. The chief dangers 
of the punctured wound are suppuration and lock-jaw. 
Lock-jaw is caused by a germ which does not require oxygen 
for its existence; a germ, in fact, which will not develop in the 
presence of oxygen. Such germs, when deposited deep in the 
tissues, are deprived of the free oxygen and are in a situation 
favorable to their growth. 



CONTUSIONS AND WOUNDS 81 

We, therefore, speak of this germ as being non-aerobic, 
because of the facts that a punctured wound passes deeply 
into the tissues, that the entrance of the wound is small, and 
that it tends to thus prevent drainage, allowing germs which 
consume oxygen to multiply, shutting off the outside air 
which antagonizes tetanus. Germs of lock-jaw are prone to 
thrive in such wounds. The germs of lock-jaw lurk particu- 
larly in the dirt and refuse around stables, in street dirt, in 
the dust of garrets and in dark cellars. The public thinks a 
rusty nail particularly dangerous, but the peril is not in the 
rust itself. 

The rust makes the nail rough, and a rough nail catches 
and holds more bacteria than a smooth nail. 

Treatment. — The treatment of such wounds is based on 
two principals: first, the wound must be at once thoroughly 
disinfected, so that all pus germs and germs of lock-jaw may 
be killed; and secondly, the wound must be kept open by a 
small drain so that the mouth of the wound will not close and 
allow infected fluids to gather beneath, which would prevent 
oxygen from the air freely entering the wound. The penetrat- 
ing instrument (needle, nail, etc.), if still sticking in the tissues 
should be withdrawn from the wound and should be carefully 
inspected to see if any part of it has been broken off in the 
wound. 

A clean dressing is then placed over the wound and the case 
should be at once referred to a physician. The physician incises 
the wound, thus converting the puncture into an incised wound. 
After it has bled freely, the wound is disinfected. The skin 
around the mouth of the wound is disinfected preferably with 
iodine. The wound to its very depth is swabbed with pure car- 
bolic acid. A piece of cotton is wrapped on the end of an ap- 
plicator. The cotton is then saturated with pure carbolic acid. 
Alcohol is then sponged around the surface of the wound to 
counteract the excess of carbolic acid, which may flow into 
the skin. A drain of gauze or preferably of rubber tissue is 
inserted to the depths of the wound and a sterile dressing is 
applied. Some use iodine instead of carbolic acid with which 
to swab the wound. The iodine for disinfecting such a wound 
shouM be the full strength of tincture. Lunar caustic, which 



82 



TREATMENT OF EMERGENCIES 



is a stick of silver nitrate, is not to be used in such a wound. 
The stick itself is often dirty, having been exposed to the air 
for a length of time or having been used on other cases. Mor- 
over, it forms a crust in the raw parts which as previously stated 
imprisons the discharge and prevents free drainage. If the 
wound is not large enough to permit the application of carbolic 
acid to its depths, and to render drainage easy it should be 
unhesitatingly enlarged. The physician uses a sterile scalpel 




Fig. 61. — Use of tetanus antitoxin following a puncture wound. 



or bistoury to enlarge the wound. In an emergency, however, 
the blade of a pen knife may be used after the blade has first 
been sterilized by subjecting it to the heat of alcohol flame, 
or by plunging it into boiling water, and then allowing to cool. 
In the fire department we make a rule that all punctured 
wounds must be thoroughly opened and explored. In a large 
percentage of cases of punctured wounds of the sole of the foot, 
a piece of rubber boot is found lodged deep in the tissues, 



CONTUSIONS AND WOUNDS 83 

having been carried there on the point of the nail on which 
the fireman trod. 

There has been but one case of tetanus in the Philadelphia 
Fire Department in forty-four years, although many punc- 
tured wounds occur each week. This solitary case of lock- 
jaw resulted from cutting the hand with window glass. The 
fact that the nails upon which the firemen tread have in many 
cases been subjected to the heat of the fire may have some 
bearing on the absence of tetanus. It is believed, however, 
that the main factor is that the firemen are so well educated 
to the dangers of punctured wounds that they present them- 
selves for immediate treatment and always come knowing that 
the wound is to be opened, explored, cauterized and drained. 
After the wound is treated and dressed, a prophylactic dose 
of lock-jaw antitoxin should be given. A prophylactic dose 
is a preventive dose. Fifteen hundred units of antitoxin are 
injected into the loin (see Fig. 61). 

Never give the antitoxin in the arm or leg, as in those parts 
there is little loose tissue and the injection causes tension and 
pain. Always caution the one receiving the antitoxin that 
it may cause nausea, vomiting or hives during twenty-four 
or even forty-eight hours. 

STAB WOUNDS 

A stab wound is inflicted by a sharp pointed instrument 
such as a dagger, a bayonet, a knife, etc. Blood vessels are 
not pushed aside as in punctured wounds, but are cut, profuse 
hemorrhage resulting. Shock is usually great, especially if 
the instrument has penetrated the chest, the abdomen, or 
skull, or has cut a large vessel. 

Treatment. — Check the hemorrhage which may be either 
venous or arterial (see page 102). Apply a clean dressing 
and treat the shock. 

Wounds from Fish Hooks. — Wounds caused by fish hooks 
are painful and are often difficult to manage because the end 
of the hook catches in the tissues and any attempt to with- 
draw it tears the tissues and causes great pain. In some cases 
the best plan for removing such a hook is to push the hook on, 



84 TREATMENT OF EMERGENCIES 

make the barbed end protrude through the skin, and pull the 
rest of the hook after it, or cut off the protruding ends with 
pliers and withdraw the remaining portion of the hook.. In 
cases in which the barbed end protrudes through the skin the 
same procedure may be followed. In many cases in which 
the barbed point is buried, it is necessary for a physician 
to cut down upon the foreign body to effect extraction. The 
wound in any case should be either swabbed with iodine or 
with pure carbolic acid. If acid is used, the excess of the acid 
must be washed from the skin around the wound with alcohol. 
The wound should be drained and with gauze wet with hot 
bichloride of mercury solution in the strength of 1 to 4000. 

POISONED WOUNDS 

A poisoned wound is a wound into which some poisonous 
material is introduced at the time the wound is received. By 
this term we do not mean wounds infected with bacteria but 
wounds which contain non-living organic, or vegetable poison. 

Snake Bites. — In a snake bite the venom of the snake is 
introduced into a wound, by means of the fangs of the snake. 
The most poisonous snake in the world is the cobra. It is an 
inhabitant of British India and some other parts of the East. 
This snake is never found in the United States. The poison- 
ous serpents of the United States are the rattlesnake, the 1 
copperhead, the water moccasin and the coral snake. There 
are several different species of rattlesnakes; one species is 
found in marshy districts, another in wooded country, another 
in the rocky land and another in the prairie lands of the West. 

Copperheads and moccasins are found in the Southern 
States, in the Middle Atlantic States and in some of the New 
England States. Copperheads are usually found in fields 
or near forests while moccasins inhabit marshy lands. Rattle- 
snakes, copperheads and moccasins have long, hollow movable 
fangs through which the venom or poison is injected. These 
fangs lie in a fold of mucous membrane upon the roof of the 
mouth, until the snake is ready to strike. Then the fangs 
become erect and are carried to the front of the mouth. 

The fangs strike once into the tissues, the poison being 
injected at this moment by contraction of the poison bag. 



CONTUSIONS AND WOUNDS 85 

The coral snake is found most frequently in the fields of the 
Southern Atlantic States. A coral snake, like a cobra, has 
short rigid erect fangs. The coral snake strikes like the cobra. 
It grasps the victim with its fangs, chews the tissues, making 
many punctures and injecting the venom at each puncture. 

A few minutes after a person has been bitten by a poisonous 
snake, the injured part becomes painful, swollen and dis- 
colored. The discoloration may be either red or purplish in 
hue. In some cases there is nothing beyond this local dis- 
turbance. In other cases the poison enters the circulation 
and causes dangerous blood poisoning. The patient becomes 
sick at the stomach and vomits. There may be severe pros- 
tration, the patient breaking out in a cold sweat, the hands and 
feet becoming cold and the skin clammy, the pulse becoming 
weak and rapid. There may be unconsciousness, delirium or 
convulsions. Death may occur in four or five hours, or may 
not ensue for several days, or the condition may be recovered 
from. The death rate from snake bites varies from 4 to 5 per 
cent, to 20 or 25 per cent. 

The danger depends on the part bitten, the activity of the 
venom, the amount injected and the promptness with which 
the treatment is inaugurated. A large snake is more danger- 
ous than a small one of the same species, and an active snake 
is more dangerous than one which is partly torpid. Wounds 
on the bare skin are more dangerous than bites inflicted 
through clothing. Bites of the face are particularly dangerous. 

Treatment. — Several tourniquets should be placed at differ- 
ent levels, on the limb above the region bitten, that is, between 
the trunk of the body and the bite (Fig. 62). The tourniquets 
are placed in position in order to keep as much of the poison 
as possible from getting out of the limb into the general 
circulation. If a knife is at hand the blade should be sterilized 
by heat, a crucial incision be made directly in the area bitten, 
and the wound encouraged to bleed freely. The wound 
should be swabbed with pure carbolic acid or pure nitric 
acid, if either chemical is at hand. The wound may be cau- 
terized by means of the red-hot blade of a knife. Crystals 
of permanganate of potash may be rubbed into the wound. 
The practice of sucking the wound caused by a snake bite 



86 TREATMENT OF EMERGENCIES 

is a dangerous one, because if the one who sucks the wound 
has an abrasion of the lips, or mouth he may himself become 
inoculated with the venom. 

Hunters sometimes cauterize a snake bite after incising it 
by putting a small amount of gunpowder into the wound, and 
then igniting the powder. If tourniquets are used, they 
should be removed as follows: The tourniquet nearest the 
trunk of the body is first removed, then after a little time if no 
symptoms develop the next lower tourniquet is removed and 
so on until all are removed. 



Fig. 62. — Multiple tourniquets for snake bite of the foot. 

Many cases have been successfully treated by the use of 
anti-venene serum. This serum is obtained from blood liquor 
of a horse which has been rendered immune to snake venom by 
giving the animal at first a small dose of the snake venom, 
and then gradually increasing the dose until immunity is 
established. A different serum must be used for the bite of 
each species of snake. The serum made to treat the bite of 
the coral snake (columbine) is inert in a case of the bite of a 
rattlesnake (viperine) and vice versa. 

The victim of a snake bite usually suffers shock. He should, 
therefore, be kept warm, all clothing should be loosened and 



CONTUSIONS AND WOUNDS 87 

stimulants should be given. Aromatic spirits of ammonia 
is a valuable stimulant. Whiskey or brandy in moderate 
doses are esteemed useful. In large doses, they tend to cause 
depression, and large doses do more harm than good. This is 
contrary to the general belief of the public. 

Insect Bites and Stings.- — The poison sac of a bee communi- 
cates with two long stingers or lances which lie inside of a 
sheath. When the bee stings, the sheath makes the wound, 
then the lances move back and forth to deepen the wound and 
lacerate the tissues. At the same time the poison is injected 
into the wound. The sensation to the victim being stung is 
as though a hot needle were passing into the tissues. This pain 
continues acute for some time. In a few minutes, the part 
becomes swollen and red. The acute pain is apt to subside 
within a few hours.* There is usually little danger in the sting 
of a bee. If, however, a number of stings are received at the 
same time, the part or parts may become badly swollen and 
the victim may suffer from shock. Bee stings have caused 
death. If the stings are received about the face, the swelling 
may close the eyelids. 

The stings of wasps, hornets, and yellow jackets cause 
similar symptoms. 

Treatment. — The sting may remain in the wound. If it 
does, it should be removed by a pair of small forceps or a 
needle. The instrument used is, of course, first sterilized. 
Often pressure made by means of the barrel of a key placed 
directly over the wound will force the sting into view and so 
render its removal easy. After the removal of the sting the 
wound should be touched with a drop of ammonia or a drop 
of pure carbolic acid or the part should be bathed in ammonia 
water. 

Baking soda made into a paste with water, or a paste of 
ordinary table salt and water, when laid upon the part will 
give comfort. A dressing of lead water and laudanum is 
soothing. If shock is present, it must be met with appro- 
priate treatment (see page 109). In stings about the face, 
if the eyelids be so badly swollen that the eyes are closed, cold 
compresses should be applied to the eyes (see page 65) and 



88 TREATMENT OF EMERGENCIES 

the eyes should be frequently Washed with a solution of boric 
acid (see page 200). 

Other Insect Bites and Stings. — A tick, after biting a 
person, clings to the skin. A little ammonia dropped on the 
insect will cause it to withdraw its barb and the assailant may 
then be removed. 

A drop of pure carbolic acid upon the wound will relieve 
the itching. The bites of many spiders are poisonous. The 
poison may remain localized in the area bitten, the symptoms 
being entirely local, or may be diffused, causing general 
symptoms. 

The tarantula is a very poisonous spider. Its bite may be 
followed by severe inflammation and swelling of the part, and 
may cause great prostration and even death. The scorpion 
has a stinger in its tail. The sting of a scorpion is apt to 
produce not only great local pain and swelling but also 
headache, vomiting, profuse sweating, dizziness, great weak- 
ness, and prostration. The area of the part stung often 
becomes infected and may become gangrenous. 

Treatment of Bites of Poisonous Spiders and Stings of 
Scorpions. — A tourniquet should be placed above the sting 
as in a snake bite. The wound should be incised, bleeding 
favored, and cauterization with pure carbolic acid is to be 
practised. The wound should be dressed with gauze wet with 
a solution of bichloride of mercury of a strength of 1 to 4000. 
If there is shock, prostration, etc., it should be treated as for 
shock (see page 109). 

The sting of a centipede is seldom serious. It requires only 
local treatment as for the stings of bees. 

Occasionally an insect crawls into the ear of a sleeping 
person. In such a case it is best to introduce a few drops of 
laudanum into the ear. This will either make the insect crawl 
from the ear or it will kill it and may then be removed by a 
pair of forceps. Do not attempt to grasp a live insect and 
pull it out as it may thus be broken in half and one-half be 
left in the ear. To remove the dead insect from the ear, see 
page 193. 

The chigger or jigger is a species of sand flea. It is most 
common in the tropics but is also prevalent in the Southern 



CONTUSIONS WD WOUNDS 89 

States of this country. The female attaches herself to the 
skin and burrows beneath it. This burrowing causes a stinging 

pain to the victim. The head of the insect remains embedded 
in the deeper parts and its abdomen begins to swell, and finally 
sets free a large number of eggs. 

Treatment. — The burrow in the tissues made by the insect 
should be enlarged with a probe or needle, so that the insect 
can be dug out. The wound should then be painted with 
iodine. 

Stings of Fishes. — Cuts, or juncture wounds received from 
the spines of certain fishes are often poisonous. Such wounds 
are very painful and swell rapidly. The wound should be 
enlarged sufficiently to permit cauterization with carbolic 
acid, following which the surrounding parts are washed with 
alcohol. The wound may be swabbed with the full strength 
of tincture of iodine instead of pure carbolic acid. A wet 
bichloride dressing 1 to 4000 should then be applied. 

Wounds received while dissecting cadavers or wounds 
received while working upon any dead animal are apt to be 
dangerous. 

Such a wound should be cauterized. If the wound be a 
puncture wound, it should be enlarged, cauterized, with pure 
carbolic acid, the surrounding parts being washed with alcohol. 

Instead of carbolic acid a solution of chloride of zinc, gr. 
xxx to one ounce of water, may be used as a disinfectant to 
the wound. Drainage is placed in the wound and a dressing 
wet with bichloride of mercury of a strength of 1 to -1000 is 
applied. Wounds received from oyster knives or the shells 
of oysters are prone to infection. Such wounds should be 
carefully washed out with peroxide of hydrogen. All pieces 
of oyster shells and all dirt should be removed. The peroxide 
is then washed out of the wound with sterile water and drainage 
is established. A bichloride dressing, 1 to 4000, is then 
applied. 

Hydrophobia or Rabies. — Hydrophobia is transmitted from 
animals to man. It is usually transmitted from dogs, but 
can be transmitted from cats, wolves, horses, foxes, sheep or 
pigs. The rabid animal does not necessarily have to bite 
a man to infect him; if the saliva of the rabid animal comes 



90 TREATMENT OF EMERGENCIES 

into contact with an abrasion, or any open sore, hydrophobia 
may ensue. If the bite of a mad animal is made through 
the clothing, the infected saliva may be wiped off and the 
disease is not nearly so likely to develop as when the bite is 
inflicted upon an exposed area of the body (hand or face) . 

In the dog, the disease usually manifests itself three to 
five weeks after infection. The dog becomes depressed, irri- 
table, snappish, restless, and exhibits a tendency to mope in 
a dark corner, a cellar, or under a shed. The appetite becomes 
depraved and the animal eats rubbish, dirt or even its own 
excreta. The mouth is filled with a thick saliva. 

This is a very dangerous stage, because at this -time the 
condition is seldom recognized as hydrophobia. As the disease 
progresses, the dog develops convulsions, the bark loses its 
characteristic ring and becomes hoarse. Paralysis is usually 
the final stage. Occasionally the dog becomes greatly excited, 
in fact maniacal, and runs loose, biting at imaginary objects 
and at every person and everything it passes. 

In man, the symptoms usually appear about forty days (on 
an average) after becoming infected. The disease may not 
make its appearance for even three or four months, after the 
infection, rarejy, however, after six months. The disease is 
ushered in with headache, and a peculiar sensation in the head 
and often pain in and about the scar of the bite. The mind 
becomes confused. The victim becomes apprehensive of 
impending evil and often actually fearful. This is followed by 
restlessness and sleeplessness. There follows an inability to 
swallow not only water but any food whatever. Breathing 
becomes short and jerky. There is often a loud hiccoughing 
which by imaginative people is sometimes thought to resemble 
the barking of a dog. Convulsions may occur. The patient 
usually dies of exhaustion, and unfortunately is conscious 
until the very end. When hydrophobia once develops it is 
invariably fatal. The prevention of the disease is of para- 
mount importance. 

Treatment. — If a person is bitten by an animal which is 
supposed to be mad, the wound should be at once cauterized. 
First put a tourniquet above the wound, if the wound is on 
an extremity. If the wound is a punctured wound or is too 



CONTUSIONS AND WOUNDS 91 

small to disinfect satisfactorily, it should be opened freely. 
Favor bleeding. Cauterize the wound with fuming nitric 
acid, or pure carbolic acid. A red-hot blade of a pen knife 
may be used. Don't rely on silver nitrate (see page 82). 
Dress the wound with gauze wet with bichloride of mercury 
in the strength of 1 to 4000. Until recently if a person were 
bitten by a rabid or a mad animal, he was sent to a city where 
there was a Pasteur institute. Now, however, he can receive 
this treatment by having a dose sent each day to be injected. 
This treatment is a preventive treatment and consists in the 
injections of an emulsion of the spinal cords of hydrophobic 







W[ «** flas H**.ri *-\™«»™ *fcH « 


jL^^-^ 


ESHSS8 * 



Fig. 63. — Outfit for giving; Pasteur treatment. 

rabbits. The virus of the emulsions is attenuated and each 
day the strength of the injected virus is increased. Twenty- 
five injections are given. Fig. 63 shows a complete outfit for 
this treatment. The cost of this emulsion is about fifty dol- 
lars. The mortality of those who have been treated by the 
Pasteur is less than 1 per cent. Before the inauguration of this 
treatment 14 per cent, of those who were bitten developed 
hydrophobia and all those who subsequently developed hydro- 
phobia died. The animal which did the biting should, if pos- 
sible, be locked up and watched instead of being killed. By 
this procedure it can be proved whether or not the animal was 



92 TREATMENT OF EMERGENCIES 

infected with hydrophobia. If the dog was killed or dies, the 
head should be cut from the body with a knife, the blade of 
which has been rendered sterile by boiling or passing through a 
hot flame. The brain of the dog should be placed in a jar 
which contains equal parts of glycerine and sterile water. 
Both the jar and the solution of glycerine and water should 
have been previously sterilized by boiling. This bottle should 
be sealed and sent to a reliable laboratory for examination of 
the brain. If such a procedure is not practical, the body of 
the animal should at once be sent to a reliable laboratory 
for examination of the animal's brain. Animals may become 
mad at any season of the year not, as many believe, only 
during "dog days." There is as much hydrophobia in winter 
as in the summer. Rigid enforcement of the muzzling ordi- 
nance would stamp out the disease here, as it has in England. 

GUN SHOT WOUNDS 

Gun shot wounds may be divided into two mam groups: 
namely, those caused by the soft lead bullets, used in civil 
life; and those caused by bullets with jackets of steel or other 
hard metal, which are used in military life. 

Gun shot wounds from soft bullets comprise wounds made 
by the sporting rifle and by the ordinary revolver of civil life. 

The bullet of the sporting rifle may have no jacket or may 
have an incomplete or short jacket. Those having a partial 
jacket have a "soft" nose made of lead. Such a bullet tends 
to mushroom, when it hits an object and causes a frightful 
lacerated wound. 

The bullet of the revolver of civil life is lead and has no 
jacket. When it strikes a person, it is apt to be deformed and 
lodge in. the tissues. Such a bullet is easily deflected. Ten- 
dons or bone may change its course. It may push aside blood 
vessels. 

Primary hemorrhage from such a wound is not usually 
severe. Secondary hemorrhage, however, is not unusual as, 
though a large vessel may be pushed aside in the course of the 
bullet, yet the vessel which was touched was contused, and 
there may be subsequent hemorrhage from rupture of the 
contused vessel. 



CONTUSIONS AND WOUNDS 93 

The bullel of such a revolver tends to carry into the wound 
pieces of clothing, and the wound practically always is in- 
fected. This infection may be responsible for secondary 
hemorrhage. 

If the bullet does not lodge, it will make a wound of exit. 
The wound of exit is larger than the wound of entrance, be- 
cause the shape of the bullet is altered in its course through 
the tissues. 

Bone, tendon, ligament, if struck, will deform the bullet. 
A wound of exit will be very large, if the bullet comminuted 
a bone, as fragments of bone are carried out with the ball. 
If the velocity of the bullet is nearly spent, when it strike-. 
the bullet may not enter the skin, but may merely cause ;i 
brush burn or a contused wound. 

For medico-legal purposes a bullet wound should be care- 
fully inspected. If the bullet strikes the skin at a right angle 
the wound of entrance is somewhat circular. If the bullet 
strikes at an acute angle the wound of entrance will be oval 
or linear in shape. 

The skin surTace is blackened. This blackened appearance 
of the skin is due to a burn of the skin if the bullet has been 
tired at close range. If the skin is burned it i> dry like 
parchment, and the blackened area can not be washed off. 
If the bullet was not fired at a close range, there may be :i 
blackened area around the wound of entrance due to the grease 
and burnt powder on the bullet — this can be washed off. 

If the bullet has been fired at close range, within eighteen 
inches, the skin may be burned. This burn may be due either 
to the action of the gases, or to the clothing which may burn 
and scorch the skin. 

Tattooing of the skin is due to the embedding in the skin 
of unexploded powder grains. This always means that the 
bullet was fired at close range. 

If the muzzle of a gun, when fired, is held firmly against the 
skin the resulting wound is large, ragged and badly contused 
due to the explosive effect of the gases. 

The wound of exit must also be studied. It must be re- 
membered that one bullet may make more than one wound 
of entrance and exit. For example, a bullet may penetrate 



94 TREATMENT OF EMERGENCIES 

the arm, causing a wound of entrance and a wound of exit, 
and may then penetrate the chest, causing a second wound of 
entrance and exit. Therefore, a number of bullet wounds 
does not necessarily mean that several bullets have been 
fired. 

If an undeformed bullet, that is a bullet which has not been 
flattened, emerges from the body, the wound of exit will 
never be powder-marked, nor will the surrounding skin be 
burned. The wound of exit is slightly larger than the bullet. 

If the bullet has been flattened, or if the bullet has carried 
before it any article which it may have struck, such as a metal 
button, a buckle, or if it has driven bone before it, the- wound 
of exit will be large and the tissues badly lacerated. 

Treatment of Wounds Caused by a Non-jacketed Bullet. — 
The victim of a gun shot wound is usually shocked and must 
be treated accordingly (see page 109). Internal hemorrhage 
may be present and the symptoms should be watched for 
and treated (see page 115). 

Primary hemorrhage in wounds caused by a non-jacketed 
bullet is not usually severe. Arterial bleeding is temporarily 
checked by means of digital pressure or by the application of 
a tourniquet, a tight bandage, or a rubber band above the 
wound. Venous hemorrhage is checked by packing the wound 
with plain gauze, iodoform gauze and the application of a 
firm bandage over the dressings. The wound should be 
dressed with antiseptic gauze. 

If the wound be lacerated, it should be swabbed with the 
iodine before being dressed. If the bullet has fractured a 
bone, the proper splint or dressing should be applied over the 
gauze dressings in order to put the part at rest. Never put 
any instrument into the wound and never attempt to probe 
the wound. Such procedures, if practised at all, must be 
done only by a surgeon. 

The victim of fire arms should always receive tetanus 
antitoxin (1500 units). 

Wounds Caused by the Military Bullet. — The military 
bullet has a core of lead hardened by the addition of 2 per 
cent, of antimony, enclosed in a jacket made of a copper, 
nickel or steel alloy. At a range of 1500 to 2000 yards, this 



CONTUSIONS AND WOUNDS 95 

bullet seldom lodges but usually penetrates the part struck. 

At a range of 500 yards or less, the bullet may have an 
explosive effect. This explosive effect may occur at a greater 
range if an organ such as the liver, lung, spleen, or bladder 
(containing urine) is struck. 

At long range, when the bullet is almost spent, the bullet 
may not hit "nose on" but may hit "broadside," thus inflict- 
ing a large lacerated wound, similar to the wound caused by a 
non-jacketed bullet. 

The present war in Europe has upset many of the traditions 
and teaching concerning wounds caused by military bullets. 

The military bullet was believed to be humane. It was 
said that it seldom carried dirt, clothing or other foreign 
material into the wound, that primary hemorrhage was not 
uncommon as blood vessels were cut or penetrated, not pushed 
aside, that secondary hemorrhage was uncommon and that 
the wound seldom became infected. 

The present war has shattered these beliefs. Modern t rench 
warfare has profoundly modified the character of military 
wounds, and their treatment has been completely changed. 

A large proportion of wounds in the present war are infected. 
I am not referring to wounds caused by hand grenades, 
shrapnel, etc., which are always infected, but am referring to 
wounds inflicted by bullets, thrown by rifles or machine 
guns. 

The two most serious forms of infection have been tetanus 
or lock-jaw and gas-gangrene. 

The ground over which these troops are fighting has for 
centuries been cultivated. Fertilizing agents have been used 
year after year. The soil is, therefore, saturated with the 
germs of lock-jaw, gas-producing organisms and many other 
germs. This condition has caused the wounds to reek with 
infection. 

Trench warfare renders wounds peculiarly liable to infection. 
Bullets are very apt to strike the ground before striking the 
soldiers. Dirt is carried into the wound. Dirt may be carried 
into the wound from the uniform or even from the soldier's 
skin. 



96 TREATMENT OF EMERGENCIES 

First Aid Treatment of Wounds Caused by the Military 
Bullet. — As the nature of the wounds caused by the military 
bullet has been different in this war than in previous wars, so 
too the treatment has had to be different. 

First aid treatment of such wounds was formerly to check 
hemorrhage, and to place upon the wound a compress of sterile 
gauze. 

If there were a wound of exit, as well as a wound of entrance, 
a piece of sterile gauze was placed on each. This rule is still 
applicable in a wound caused by a military bullet under 
conditions other than in trench warfare. 

During the first months of the present war, a large majority 
of those wounded developed tetanus. A preventative or 
prophylactic dose of tetanus antitoxin is now given every 
wounded soldier, as part of his first aid treatment. 

Gas-gangrene is the common complication of wounds. 
Such wounds are now treated by the Dakin-Carrel method and 
the results during 1916 were good. Multiple drains are 
inserted and. an antiseptic dressing is applied. Rifle bullet 
wounds, which we used to consider as practically clean wounds, 
have in the present war been highly infected wounds, and have 
caused a very high mortality. 

Wounds Caused by "Soft Nose or Dum Dum Bullets." — 
Dum dum bullets are so called because they were first made 
at the Dum Dum arsenal (outside of Calcutta). These 
bullets are made wholly of lead free from antimony. The 
end of the nose of the bullet has no mantle or jacket. The 
result is that when such a bullet strikes, the soft lead nose 
flattens and, consequently, inflicts a mutilating wound, 
destroying and pulpifying tissues and fracturing bone. 

A wound similar to the wound produced by a dum dum 
bullet may be produced if the end of the jacket of an ordinary 
military bullet is cut away leaving the lead cover exposed. 

A similar wound may be produced if the regular military 
bullet strikes the ground, a stone, a gun carriage or some such 
hard object, flattens out, ricochets, and then strikes a soldier 
in its new distorted shape. 

Wounds Made by Blank Cartridges. — A blank cartridge 
makes a dangerous wound. It can occur only at close range. 



CONTUSIONS AND WOUNDS 97 

The chief danger is the subsequent development of tetanus or 
lock-jaw. 

It is believed that germs of lock-jaw lurk in the horse hairs 
which are used to make the wad of the blank cartridge. A 
piece of the clothing may be carried into the wound. 

Treatment. — Any foreign body should be removed from 1 lie 
tissues. The wound should then be cauterized with pure 
carbolic acid, the excess of the acid being sponged off with 
alcohol. A clean dressing is then applied. Iodine may be 
used instead of carbolic acid to disinfect the wound. If the 
wound is deep, it should be drained. A prophylactic dose of 
tetanus antitoxin (1500 units) should always be given. 

Wounds from Shot Guns. — The amount of destruction 
caused by a shot gun depends upon the size of the shot, the 
size of the charge and the distance of the person shot, from the 
gun. The greater the distance, the more the shot will spread. 
The more they spread the greater the surface of the body 
through which they enter and the less depth to which they go. 
If the gun is near the person shot, the wounded part is not as 
great in area, but much greater in depth and in extent of 
destruction of tissues. In such a close-range wound the shot 
enters like a single large projectile. At close range a shot gun 
may blow off a hand, or a foot, or may tear muscles apart or 
even fracture bones. If the distance is great, the shot will not 
be deeply embedded. 

Treatment. — The treatment of a shot gun wound is to stop 
hemorrhage, keep the wound clean by applying a compress 
of sterile gauze, and treat the accompanying shock. As the 
wound is a lacerated wound, the hemorrhage is not usually 
severe. It is impractical to attempt to remove all the shot 
except that which is lodged in the face or in a joint. 

A surgeon must be called upon to do this. If a single shot 
lodges in the eyeball, the sight of the eye may be destroyed 
and the eye may subsequently have to be removed. 

A person suffering from a shot gun wound should always 
be given tetanus antitoxin (1500 units). 



CHAPTER III 
HEMORRHAGE 

Hemorrhage is escape of blood from a blood vessel, whether 
the vessel be an artery, a vein or a capillary. Hemorrhage 
may be due to an injury or may be due to disease. In scurvy 
the gums bleed, because they are diseased. In typhoid fever, 
there may be bleeding from the intestines. Hemorrhage may 
be confined to the tissues underneath the skin, as in a case of 
severe contusion. Black and blue areas, following any injury, 
signify hemorrhage into the tissues under the skin. Children, 
elderly people, alcoholics and those suffering with disease of 
the kidneys stand hemorrhage very badly. Children react, 
however, more quickly than do the elderly. Sudden hemor- 
rhage is more dangerous than slow hemorrhage. 

Varieties of Hemorrhage. — Hemorrhage may be arterial 
(from an artery), venous (from a vein), or capillary (from 
capillaries) . 

Arterial Hemorrhage.— -The arteries carry the blood from the 
heart to the tissues throughout the body. 

Oxygen is an important constituent of the red blood cells. 
Each time the heart beats, blood is propelled from the heart 
into the arteries. 

If an artery is cut, the blood spurts from the wound with 
each beat of the heart. 

Blood from an artery is scarlet as it contains a large amount 
of oxygen. 

Hemorrhage From a Vein. — After the blood has been carried 
to all of the tissues of the body and has nourished these 
tissues with oxygen, it returns to the heart by way of the veins. 
When the blood reaches the veins it has been deprived of its 
oxygen ; the color of the venous blood is not, therefore, a scarlet, 
but is dark red in color. In severe hemorrhage, when the 
patient is greatly shocked, the venous blood is almost black. 

98 



HEMORRHAGE 99 

By the time the blood reaches the veins, it has lost the direct 
spurting from the heart. This is due to the multitudes of 
capillaries interposed between the arterioles and venules. 
Venous blood flows in a steady uninterrupted flow. 

Capillary Hemorrhage. — The capillaries are small blood 
vessels which convey the blood from the small arteries to the 
small veins. In every wound capillaries bleed. Capillary 
bleeding is seen characteristically in a wound such as a ''brush 
burn." On the raw surface of such a brush burn will be seen 
innumerable small points oozing blood. The blood does not 
spurt as blood from an artery, nor does it flow steadily as blood 
from a vein, but the blood wells up in the wound. The whole 
surface of the wound seems to be weeping with blood. In 
capillary bleeding in a deep wound the blood will trickle down 
into the wound and the wound will fill up from the bottom with 
blood. 

In an extensive wound there ma}' be all three of the varieties 
of hemorrhages combined. There will be a continuous flow 
of venous blood from the wound, rhythmical spurts of blood 
from one or more arteries, and oozing from the capillaries. 

A hemorrhage may be slight, severe or profuse. 

Slight hemorrhage follows a trivial injury to a small blood 
vessel. Such hemorrhage exists for a few minutes and is 
either checked by nature or is readily amenable to simple 
treatment. Hemorrhage of such nature is not accompanied 
by any constitutional symptoms such as shock. 

If the bleeding occurs from a large vein or artery or from 
both vein and artery, the bleeding will be severe and unless 
promptly checked will be accompanied by shock. The degree 
of shock depends upon the amount of blood lost. The greater 
the amount of blood lost the more serious will be the degree 
of shock. Sudden loss of blood is far more dangerous than a 
gradual loss. In the latter condition nature is given a chance 
to react, while in the former condition the heart is taken 
unaware and recuperation is more difficult. 

Profuse hemorrhage follows an extensive wound to an 
important blood vessel. If the vessels of the neck are cut in 
an attempted suicide, the hemorrhage is profuse. Blood 
escapes from the wound in such quantity that it is hard to 



100 TREATMENT OF EMERGENCIES 

find its origin. Shock is severe. Death occurs in a few seconds, 
from loss of blood or from blood entering the windpipe and 
causing asphyxia. 

Hemorrhage may differ in different kinds of wounds. 
Hemorrhage from an incised wound is usually considerable for 
a time as the edges of the wound tend to gap. If a vessel is 
completely cut, the coats of the vessel contract and thus tend 
to occlude the mouth of the vessel and to check hemorrhage. 
If the vessel is only button-holed or partially cut, it will not 
allow the coats of vessel to contract and hemorrhage is more 
profuse. Hemorrhage from a lacerated wound is not nearly 
so severe as hemorrhage from an incised wound. In a lacer- 
ated wound the vessels are usually torn completely across and 
are stretched in the tearing. Stretching pulls the elastic coat 
over the inner and favors clotting. 

Hemorrhage from a puncture wound is usually trivial. Of 
course, if an important vessel is injured by the penetrating 
instrument, the hemorrhage may be profuse. Hemorrhage 
from a stab wound may be severe. 

Constitutional Symptoms of Hemorrhage. — Trivial hemor- 
rhage will cause no constitutional symptoms. Profuse hemor- 
rhage may cause death in a few seconds. After a severe 
hemorrhage the patient becomes dizzy and weak. Black 
specks dance before the eyes. Vision is dimmed. The 
head swims. There may be nausea. There is ringing in the 
ears. The patient is very restless, is short of breath, yawns 
constantly and has an unquenchable thirst. The yawning, 
shortness of breath, restlessness and tossing are known as 
u oxygen'' hunger," as the patient is fighting to get oxygen into 
his system to make up for that which he has lost through hem- 
orrhage. 

The patient is pale, his lips are blanched and dry, and he is 
continually trying to moisten his lips with his tongue. The 
skin is cold and clammy. Beads of cold perspiration are 
on his forehead. The tongue is cold and blanched and the 
breath is cold. The eyes have a glassy stare. The pupils 
are usually dilated. The face has an anxious expression. 
Respirations are shallow and hurried. The patient sighs with 
each respiration. The pulse is rapid and weak. Such is the 
picture of shock due to hemorrhage. 



HEMORRHAGE 101 

If the patient recovers the pallor of the skin, weakness, 
and shortness of breath may persist for some time. 

Nature's Method of Arresting Hemorrhage. — Of course, 
if nature did not attempt to check hemorrhage one would 
bleed to death from a mere scratch if untreated. 

To check hemorrhage nature coagulates the blood in and 
around the bleeding end of the vessels, thus forming a blood 
clot. In dressing a wound, do not wash this clot away. 

Hemorrhage always tends to make the remaining blood 
in the body clot more quickly. 

Nature diminishes the strength of each heart beat and 
lowers the blood pressure, causing the patient to become faint. 

Faintness is, therefore, only one of nature's methods for 
stopping hemorrhage. 

The lessening of the heart action and the lowering of the 
blood pressure prevent the blood clot from being washed 
from the mouth of the vessel. In severe hemorrhage the 
patient may actually faint and during syncope bleeding may 
cease. The hemorrhage may recur when the patient reacts 
from shock. 

Nature also causes the inner coats of the injured vessel 
to contract and to retract and the outer coat or sheath of the 
vessel closes over the bleeding end, thus completely or at 
least partially occluding the vessel. Clots form between the 
outer coat and retracted inner coat (internal clot) and around 
and beyond the outer coat (external clot). 

In a severe injury external clot alone will not arrest bleeding 
permanently. Only an external clot forms during syncope. 

Principles of the Local Treatment of Bleeding. — Bleeding 
from trivial wounds can usually be stopped by pressure 
directly over the bleeding point. A piece of sterile gauze is 
placed over the bleeding point and a firm bandage is applied 
around the part. 

This dressing should be kept in place for twenty-four hours 
so that there will be no recurrence of bleeding and no entrance 
of foreign material into the wound. 

Chemical agents are occasionally used to check slight 
hemonhage, especially if the bleeding be in a cavity, such as 
the mouth or the nose. Witch hazel is commonly used. 



102 TREATMENT OF EMERGENCIES 

Its action is, however, very mild. Local application of a solu- 
tion of tannic and of gallic acid, or of silver nitrate gr. xl to 
one ounce of water is occasionally made. 

Local application of the tincture of the chloride of iron or a 
solution of the subsulphate of iron (MonsePs solution) may 
be used. 

A solution of adrenalin chloride in strength of 1 to 1000 is 
useful in nose bleed or in bleeding from the gums. 

A piece of cotton is soaked with the solution and then 
applied to the bleeding area. Peroxide of hydrogen may be 
used for nose bleed, a few drops of the full strength peroxide 
being dropped into the nose with a medicine dropper. 

Subcutaneous bleeding, that is, bleeding into the tissues 
under the skin, can be checked by the application of cold 
in the form of an ice bag, ice compresses, or cracked ice. 

An ice bag over a recent bruise will lessen the extent of the 
inevitable black and blue discoloration. Great care, how- 
ever, must be exercised in the use of an ice bag or ice com- 
presses over a part which has been wounded as, if the tissues 
have been devitalized or extensively injured, the prolonged 
use of cold may cause gangrene. 

Bleeding from Extensive Wounds. — It must be remembered 
that bleeding even from an extensive wound can be tem- 
porarily checked by digital pressure, that is, by pressure with 
the fingers. For instance, in hemorrhage from a great vessel 
of the neck, direct digital pressure must be made at once in 
order to check the dangerous bleeding temporarily until a 
permanent arrest may be secured, and also to prevent air from 
being sucked into a large vein. If bubbles of air get into a 
large vein and are sucked through the vein into the heart, 
sudden death may result. 

When bleeding occurs from one of the extremities, elevation 
of the part will assist in checking hemorrhage. 

If the bleeding of an extremity is arterial in character or if 
the bleeding is so profuse that its exact character can not be 
ascertained, *the surest method of checking the bleeding tem- 
porarily is by the use of a tourniquet. 

There are many different styles of tourniquets. The 
elastic tourniquet (see Fig. 64) is an excellent one and until 



HEMORRHAGE 



103 



recently was used in the emergency kits of the patrol wagons 
and fire trucks in Philadelphia. Because the rubber of these 
tourniquets so soon deteriorates, they are unreliable and if 
they break, the patient is plunged into renewed danger. 

In several cases these tourniquets have snapped while being 
applied. There is nothing more vexing than to have a tourni- 
quet break while it is being applied. For this reason the army 




Fig. 64. — Rubber tourniquet. 

tourniquet is now used in the police and fire departments of 
Philadelphia. 

The army tourniquet is made of heavy braided material 
(see Fig. 65). It is inexpensive and wears well. A compress 
is placed over the line of the artery. This compress should 
consist of a hard object such as a large cork, a rolled bandage, 
a piece of wood, a clothes pin, or even a stone, or a piece of coal. 
One can not always select or choose an object to act as the 



104 



TKEATMENT OF EMERGENCIES 















^Ite 


ifo 


W t 


^ wk 


L-«.,:.l':.,.__..:. 








* ifiM 



Fig. 65. — The army tourniquet. 




Fig. 66. — Spanish windlass tourniquet applied with neck tie and stick. 



HEMORRHAGE 105 

compress, but must use the object at hand which is best 
adapted to the purpose. A tourniquet may be improvised 
by the use of a handkerchief, a necktie, a leather strap, sus- 
penders, or a piece of rope. If a handkerchief is to be used 
it is folded to make a cravat. 

A compress is placed over the line of the artery, the im- 
provised tourniquet is placed over the compress and tied 
loosely around the limb, a stick or a cane is placed in the loop 









<j. 


M 






S\^T° 


n| 




Nsr-. 




iy8j 


j^^^H^H 


<mI 





Fig. 67. — Windlass tourniquet with use of clothes pin. 



of the tourniquet directly opposite the compress and the stick 
is then twisted to tighten the tourniquet (see Fig. 66). This 
is the Spanish windlass tourniquet. 

If the patient must be transported, a turn of a bandage may 
be made around the stick and limb to keep the tourniquet from 
becoming loosened. A clothes pin may be used to tighten a 
windlass tourniquet as shown in Fig. 67, or a rubber bandage 
may be applied as shown in Fig. 68. 

Petit's spiral tourniquet is shown in Fig. 69. It consists 
of two metal plates connected by strong tapes or a strap with 



106 TREATMENT OF EMERGENCIES 

a buckle. The distance between the plates is regulated by a 
screw. This tourniquet may be applied in one of two ways: 
First Method. — A small firm compress is placed directly 
over the line of the artery, and abroad thick compress over the 
outer surface of the limb. These compresses may be held in 
place by a few turns of a bandage. Buckle the tapes around 
the limb so that the plate of the tourniquet is over the broad 
pad. Tighten the tourniquet by separating the plates or 
turning the screw. 




Fig. 68.- — Rubber bandage as tourniquet. 

Second Method. — Place a small firm compress directly over 
the line of the artery and place the lower plate of the tourniquet 
directly over this compress. Buckle the tapes around the 
limb. Tighten the tourniquet by turning the screw. Fig. 70 
shows Charriere's tourniquet. It is applied in the same man- 
ner as Petit's tourniquet. 

How tightly should a tourniquet be applied? Some sur- 
geons say that the tourniquet should be tightened until the 
pulse of the extremity is lost. Others say to tighten the tour- 
niquet until the actual spurting of blood from the wound is 



IIEMOKIUlACi; 



107 



controlled; while others advise tightening the tourniquet 
until the pulse of the extremity is barely perceptible. 

It has been claimed that grievous results have followed the 




Fio. G9. — Petit'a spiral tourniquet. 




0. — Charriere's tourniquet 



application of an elastic tourniquet tightly enough to entirely 
obliterate the pulse to the extremity. It is said that subcu- 
taneous tissues have been torn and nerves permanently injured. 



108 TREATMENT OF EMERGENCIES 

I have never seen any injurious effect from the application 
of a tourniquet. The rule should be to apply the tourniquet 
tightly enough to check the hemorrhage. If a small artery 
be cut, the tourniquet will in all probability not have to be 
tightened to such an extent that the pulse to the extremity 
will be obliterated. On the other hand, if a large artery, such 
as the femoral, in the thigh, or the brachial, in the upper arm, 
be cut, the tourniquet will certainly have to be applied tightly 
enough to check the severe hemorrhage and the pulse would 
be obliterated. 

How long can a tourniquet be kept on without danger of 
gangrene of the limb? There is no set time. The tourniquet 
must be kept in place until a hospital is reached or a surgeon 
arrives when the hemorrhage will be permanently controlled. 
The tourniquet is put on to prevent a patient bleeding to 
death and hemorrhage must be checked and kept under con- 
trol even if doing so causes ultimate harm to the limb. Cer- 
tainly it does no harm at all during the short period it is usual 
to employ the tourniquet. Usually at the end of an hour a 
clot will form and the tourniquet may be loosened, but 
not completely removed. A compress of gauze firmly 
held over the wound will usually prevent the recurrence of 
the hemorrhage. If the hemorrhage starts afresh, tighten the 
tourniquet. 

As stated, the tourniquet is placed around the extremity at a 
level above the wound. After the tourniquet is applied, a 
compress should be placed over the wound. This compress 
should consist of a piece of clean gauze or a piece of cleanest 
material at hand, and is held in place by a bandage applied 
around the limb. The limb is then elevated and the patient is 
kept quiet until the arrival of the surgeon. If the bleeding 
from a wound is not so profuse or if the bleeding is not arterial, 
a tourniquet is not necessary. 

Bleeding from a vein, even from a large one, may be arrested 
by the application of pressure made by means of a compress 
directly over the wound. This compress should consist of a 
piece of sterile gauze. 

The gauze is placed over the wound and held in place by a 
bandage firmly applied. It may be necessary to pack the 



HEMORRHAGE 109 

wound with sterile gauze or with iodoform gauze before apply- 
ing the compress. 

If the bleeding is venous in character, any constriction as 
tight clothing, garters, etc., between the wound and the heart 
must be loosened so as to relieve congestion, as congestion 
increases venous bleeding. 

If the hemorrhage is not readily controlled by the com- 
press, the application of a hot compress may be serviceable. 

The compress is soaked in water at a temperature of 120° 
to 130°, is placed directly over the wound, and is held in place 
by digital pressure. As soon as this compress loses its heat 
another is applied. The heat tends to check the hemorrhage 
by stimulating the wall of the blood vessels to contract, and by 
coagulating the albumin of the blood, thus forming a clot. 

It is important that the water be sufficiently hot, as water 
which is merely warm actually increases bleeding. Water at 
the temperature of 120° to 130° is uncomfortably hot but can 
be borne by the uncovered hands. 

Hot water is not only serviceable in arresting venous hem- 
orrhage but is especially valuable in capillary hemorrhage. 

The Constitutional Treatment of a Hemorrhage. — Shock. — 
Even while the hemorrhage is being temporarily checked by 
means of a tourniquet, compress, hot water, etc., the general 
condition of the patient must receive treatment. The object 
should be first, to relieve the heart of as much extra work as 
possible by decreasing the number of beats per minute; 
secondly, to try to keep a sufficient amount of blood in circu- 
lation through the brain, as the brain contains the centers 
necessary to life and those centers must have blood to nourish 
them; and thirdly, to maintain the body warmth. 

The heart can be relieved of extra work by keeping the 
patient in a recumbent position. The heart beats are 
markedly less frequent when a person is lying down than when 
sitting or standing. The head is lowered in order that blood 
may gravitate to the brain. 

The body temperature is maintained by keeping the patient 
covered with blankets and by the application of hot water 
bottles or hot water bags. Hot bricks or hot stones wrapped 
in a piece of flannel can be used in an emergency. 



110 TREATMENT OF EMERGENCIES 

A person unconscious from shock due to hemorrhages or any 
other cause cannot feel the pain of a burn, and cannot give 
warning that he is being burned. Therefore, use great care 
that excessive heat is not employed. 

The patient should lie upon a blanket or an overcoat and 
should have a second blanket or coat thrown over him. You 
can't get a person warm if he rests upon a cold floor or the cold 
ground. All clothing should be loosened so that the patient 
can breathe freely. 

In case of severe hemorrhage where there has been great 
loss of blood, the arms should be bandaged from the fingers 
to the shoulders and the legs bandaged from the toes to the 
hips. By this procedure the blood is driven from the ex- 
tremities and more circulating blood is secured to stimulate 
cardiac contraction and to nourish the vital centers which 
preside over circulation and respiration. The question of 
the administration of stimulants during shock from hemor- 
rhage is somewhat ambiguous to the layman. 

One teacher, or author, will say that a stimulant should 
not be given for fear of again starting hemorrhage. Another 
authority will advise stimulants. The best answer to the 
question is as follows: 

If the bleeding be from a vessel of the arm or leg, stimulants 
can be given, as, if the bleeding starts again, it can be con- 
trolled by tightening the tourniquet or the compress. 

If, however, the bleeding be internal, that is in the chest, 
or in the abdomen, out of reach of the layman, do not be in a 
hurry with stimulants but allow the blood clot a chance to 
form and while waiting wrap the patient in hot blankets. 
If, however, shock deepens and the condition of the patient 
becomes worse, stimulants must be given to save life. 

If the patient is conscious and able to swallow, brandy, 
whiskey, aromatic spirits of ammonia, or hot coffee should 
be given. If the patient is unconscious or not able to swallow, 
an enema of hot salt solution or hot coffee containing brandy 
should be given. A coffee enema should contain six ounces 
of hot coffee, and one ounce of brandy. A mustard plaster 
or a hot water bag should be placed over the heart. 



HEMORRHAGE 111 

Fig. 71 shows an individual hypodermic which is used by 
the police and fire surgeons and is carried in the emer- 
gency kits. It may contain strychnine, camphorated oil, or 
morphine. 




Fig. 71. — Individual hypodermic for emergencies. 

After the patient has thoroughly leaded from shock a 
cup of hot coffee, a milk punch or a cup of hot beef juice should 
be given. 

HEMORRHAGE FROM PARTICULAR REGIONS 

Hemorrhage from Scalp Wounds. — Hemorrhage from scalp 
wounds is usually profuse because the scalp is so plentifully 
supplied with bloo'd vessels and as these blood vessels lie in 
fibrous tissue they can not retract or contract when injured. 
The hemorrhage can usually be stopped by a compress placed 
over the wound and firm pressure made upon it and against 
the skull. After hemorrhage is checked, the compress can be 
held in place by a bandage. 

Nose Bleed. — If bleeding from the nose be slight, it can often 
be checked by making pressure over the nostril of the bleeding 
side for three minutes. 

If this does not stop the bleeding, drop a few drops of 
hydrogen peroxide into the nostril with a medicine dropper. 
Always elevate the head and loosen the clothing and apply cold 



112 TREATMENT OF EMERGENCIES 

applications to the back of the neck. If clots form, do not 
loosen them by blowing the nose. 

If the hemorrhage is more severe, plug both nostrils with 
cotton or with a small strip of gauze. The cotton or gauze 
may first be saturated with a solution of adrenalin chloride, 1 
to 1000, of antipyrin 10 per cent., or of alum. Place ice com- 
presses on the forehead and bridge of the nose. Ice applied 
to the back of the neck is often advantageous. 

If these measures do not check the bleeding, the back of 
the nose must be plugged. This is accompanied by passing 
a soft rubber catheter into the nose and bringing it out the 
mouth. A pledget of gauze or cotton is fastened to the end 
of the catheter which is projecting from the mouth. Around 
the plug of cotton two strings are tied. The plug of cotton or 
gauze is then pulled into the back of the nose by pulling on the 
end of the catheter which is protruding out of the nostrils. 
The strings are pulled out through the nose, the nostril is 
packed with a piece of gauze or cotton pushed back toward 
the posterior plug and the strings are tied around the packing 
in the front of the nostrils. 

Leave the plugs in place for one or two days, then cut the 
strings. Remove the plugs in the front of the nostril first but 
hold the strings attached to the plug in the back of the nose. 
After the front plug has been removed, let the back plug drop 
back in the throat and it can then be taken out with a pair of 
forceps or probably the patient will be able to spit it out when 
it falls into the throat. 

Bleeding from Lacerated Gums. — Such bleeding occurs in 
fracture of the lower jaw, when the gums are torn. Bleeding 
from laceration of the gums can usually be checked by direct 
pressure over the site of bleeding with a piece of clean gauze. 
Make a firm pressure with the thumb. 

Bleeding from the Ear. — Bleeding from the ear may signify 
fracture of the base of the skull (see page 24). If the bleed- 
ing from the ear be severe, raise the head, place an ice bag 
behind the ear and keep the patient very quiet. A small piece 
of cotton may be placed in the ear to keep the part clean but 
the cotton must be removed at frequent intervals. 

Bleeding from the Face. — Bleeding from the lips can usually 



HEMORRHAGE 1 1 3 

be checked by pressure. The lip is grasped between the 
thumb and fingers and firm pressure is made. 

Bleeding Following a Cut Throat. — If one attempts to 
commit suicide by cutting the throat, a knife or razor is usually 
used. Occasionally an insane person will attempt to use a 
piece of broken glass. When a piece of broken glass is used, 
the object is seldom accomplished. A jagged lacerated wound 
results. The external jugular vein may be cut but the deeper 
vessels are seldom injured. 




■ 

Fig. 72. — Pressure on carotid artery. 

When a sharp knife or a razor is used, not only the jugular 
vein may be severed, but also the carotid artery and often 
the windpipe. It is very seldom that the vessels of both sides 
of the neck are cut unless the case is one of homicide. Suicides 
usually lose their courage before reaching the side of the neck 
opposite that which they started to cut. As a suicide cuts 
the throat, the head is thrown backward, the cut is made in the 
front of the neck and the great vessels on the side of the neck 
are usually missed. 

If the large vessels are cut, death usually ensues within a 
few minutes. The treatment must be aimed at the arrest of 
hemorrhage and, if the windpipe has been opened, to remove 



114 TREATMENT OF EMERGENCIES 

the clots from the windpipe (trachea), so that the victim will 
not suffocate. 

Until the surgeon arrives, the hemorrhage must be checked 
by digital pressure. Elevate the head. Pack into the wound 
a piece of gauze, a handkerchief, or a piece of the cleanest 
material at hand. Direct the pressure so as to compress the 
vessel (the carotid artery) against the spine (Fig. 72). 
Venous bleeding may be temporarily controlled by direct 
pressure in the wound and even arterial bleeding may for a 
time be restrained by pressure over the line of the artery 
below the wound. 




Fig. 73. — Pressure on subclavian artery. 

If blood clots collect in the opened widpipe they must 
be wiped out. Otherwise they might block the windpipe 
or be sucked into the bronchi and be responsible for suffoca- 
tion If the hemorrhage occurs from the large vessel at the 
root of the neck at the level of the collar bone (the subclavian 
artery) digital pressure is made as shown in Fig. 73. If the 
hemorrhage is checked by digital pressure, do not relax the 
pressure until the surgeon takes charge of the case. 

Bleeding from Wounds of the Chest. — If after an injury 
to the chest the patient expectorates blood, the lung has 



HEMORRHAGE . 115 

been injured, but in many cases of lung injury no blood is 
expectorated. 

The blood coughed up after lung injury, is often frothy. 
The patient must be put to bed and an ice bag should be 
placed over the injured side of the chest. When a physician 
takes charge, morphine is given. 

Vomiting of Blood. — Vomiting of blood does not necessarily 
mean that the bleeding point is in the stomach. The blood 
may originate from some bleeding point in the nose or throat 
and be swallowed or the blood may come from the lung and 
be swallowed. When the hemorrhage is from a bleeding point 
in the stomach and is recent, the blood vomited is usually 
bright red, fresh blood, whereas the blood which has remained 
in the stomach for any length of lime is very dark, clotted 
blood. 

When there is bleeding from the stomach, put the patient m 
bed. Apply an ice bag over the stomach, (live the patient 
cracked ice. 

Nothing excepting the cracked ice should be given by mouth. 
A physician usually gives morphine. 

Wounds of the Abdomen. — Following a wound to the ab- 
domen, the stomach may be injured and blood may perhaps 
be vomited. This condition has been discussed above. If 
the stomach or the intestines have been injured, blood may be 
passed by the rectum. Keep the patient quiet, place an ice 
bag over the abdomen. Give nothing by mouth for at least 
twenty-four hours, then give liquid diet for a number of days. 

Bleeding from the Rectum. — Bleeding from the rectum is 
usually due to piles. To stop bleeding from the rectum, 
elevate the buttocks upon pillows. Inject six ounces of ice 
water into the rectum, by a fountain syringe or by an infant 
rectal syringe. If this fails, inject a few ounces of cold witch 
hazel. Place an ice bag against the crotch. Keep the 
patient quiet. 

Bleeding from the Male Urethra. — Bleeding from the male 
urethra can be checked by pressure in the crotch. A folded 
towel is placed in the crotch and firm pressure is made. This 
pressure can be maintained for a number of hours by placing 
a pad in the crotch and then place the handle of a crutch 



116 TREATMENT OF EMERGENCIES 

against the pad and the end of the crutch against the foot of 
the bed (Fig. 74). After the bleeding is checked, keep an 
ice bag in the crotch. It is, of course, difficult for the non- 
medical observer to know whether the bleeding is actually from 
the urethra or bladder. It is, therefore, advisable to place an 
ice bag over the lower part of the abdomen, as well as in the 
crotch. Keep the patient quiet. 

Bleeding from the Womb or Uterus. — Put the patient 
at once to bed. Place an ice bag on the lower part of the 
abdomen. Give a teaspoonful of ergot with a half glass of 
water. 




Fig. 74. — Method of making pressure in perineum or crotch. 

Persistent Bleeding from a Tooth Socket after Extraction 
of a Tooth. — Direct application of a piece of ice will often 
stop bleeding from a tooth socket. A spray of ethyl chloride 
may be used. If these measures are not satisfactory, plug 
the tooth socket with a piece of cotton soaked in witch hazel, 
in a solution of tannic acid, or of adrenalin chloride, 1 to 1000. 
If this fails, plug the socket with gauze and hold the lower 
jaw tightly against the upper jaw with a four-tailed bandage 
(see Fig. 9). Caution the patient against trying to suck 
the blood out from the tooth socket as this will tend to in- 
crease the hemorrhage. 

Wounds of the Extremities. — The line of the brachial artery 
or artery of the upper arm runs from the junction of the middle 
and outer third of the arm pit to the middle of the front of the 
elbow, when the arm is at right angles to the chest, and the 
hand in supination. 

Arterial hemorrhage from a wound in the arm must be 



HEMORRHAGE 117 

stopped by a tourniquet applied around the upper arm. 
The artery in the upper arm lies close to the bone. The 
tourniquet by pressing the artery against the bone arrests the 
bleeding. In the forearm, the arteries lie deeply in the tissue 
and not adjacent to the bone, so that a tourniquet applied 
to the forearm is not so certain as one applied to the upper 
arm. The arm should be elevated while the tourniquet is 
being applied. An Esmarch band may be used as in Fig. 
75. The band is elastic and causes tight constriction. 




Fig. 75. — Method of applying rubber tourniquet. 

Fig. 65 shows the U. S. Army tourniquet. A pad must be 
placed over the line of the artery. This pad may be a block 
of wood, a small stone, etc. Fig. 66 shows the windlass 
tourniquet, the one most frequently used in an emergency 
case from a wound. 

Should the hemorrhage come from a wound high in the arm 
pit, where it can not be reached by a tourniquet, a pad should 
be placed in the arm pit and the arm be tied firmly to the 
chest. This may check the bleeding. Occasionally this 
plan is used to check bleeding from a wound in the arm; the 



118 



TREATMENT OF EMERGENCIES 



method is not as satisfactory as the tourniquet, when the 
latter can be applied. 




Fig. 76. — Pressure on brachial artery. 




Fig. 77. — Pressure in bend of elbow. 

Severe hemorrhage from a wound in the forearm also may 
require a tourniquet placed around the upper arm for, as 
stated above, the arteries in the forearm lie deeply in the 



HEMORRHAGE 119 

tissues and bleeding can not be checked as readily by a 
tourniquet applied to the forearm as by a tourniquet applied 
to the upper arm. Instead of a tourniquet around the upper 

arm a pad may be placed in the bend of the elbow, the fore- 
arm acutely flexed on the upper arm and a bandage applied 
as in Fig. 77. This method is not as satisfactory as the use 
of a tourniquet on the upper arm. 




Fig. 78. — Pressure on femoral artery. 

Hemorrhage from the arteries of the palm of the hand is 
often difficult to check. First try packing the wound with 
gauze. Wrap the hand with gauze bandage and apply a pal- 
mar splint, reaching from the tip of the fingers to the elbow and 
place the arm in a sling. 

Instead of placing the arm on a splint, a pad may be placed 
in the bend of the elbow, the forearm flexed and bandaged to 
the upper arm (see Fig. 77). 

If the above method fails to check the hemorrhage, apply 
a tourniquet to the upper arm. 

If the hemorrhage of the palm of the hand is less severe, it 
may be checked by placing a pad of gauze over the bleeding 



120 



TREATMENT OF EMERGENCIES 



point in the palm, and then closing the fingers, thus "making 
a fist" and then firmly bandage the fingers in this position. 

Hemorrhage of the Lower Extremity. — The main artery of 
the lower extremity (femoral artery) passes from the middle of 
the groin downward and inward to the bend of the knee. 

A tourniquet can not be applied high in the groin. Bleeding 
from the artery in the groin must, therefore, be temporarily 
checked by digital pressure as in Fig. 78. Pressure so directed 
will also help to check severe bleeding from the leg. The 
leg should be elevated. 




Fig. 79. — Windlass tourniquet of thigh. 

Hemorrhage from the artery in the thigh may be checked 
by a windlass tourniquet as shown in Fig. 79, or by the Army 
tourniquet as shown in Fig. 65. The pad should be placed 
over the line of the artery. 

After the artery leaves the bend of the knee, it divides into 
two arteries which supply the lower leg. These two arteries 
lie deeply in the tissues and not directly adjacent to the bones 
of the leg and as in the case of hemorrhage in the forearm, 
hemorrhage from wounds in the lower leg can not be readily 
checked by a tourniquet placed around the lower leg. Either 



HEMORRHAGE 



121 



a tourniquet must he applied to the thigh or else a pad must 
be placed in the bend of the knee and the flexed leg bandaged 
to the thigh as in Fig. 80. 

Hemorrhage from the Foot. — Hemorrhage from a wound of 
the foot must first be retarded by elevation of the leg and foot. 

The wound is then packed with plain gauze or iodoform 
gauze which is held in place by a firm bandage. The leg and 
the foot should be kept elevated. If this procedure fails to 
check the hemorrhage, apply a tourniquet to the thigh. 




Fig. 80. — Pressure in bend of knee to control bleeding of lower leg or 

foot. 



Hemorrhage from Varicose Veins of the Leg. — Varicose 
veins are dilated and tortuous veins due to weakened venous 
valves. They are commonly found in the leg and frequently 
rupture, causing alarming hemorrhage. The leg should be 
elevated, a compress of gauze applied to the bleeding area 
and a bandage applied from the ball of the foot to the thigh. 
The patient must be absolutely quiet and not allowed to lower 
the leg for several days. 



CHAPTER IV 
SPRAINS AND DISLOCATIONS 

SPRAINS 

A sprain is a wrench of a joint due to a sudden, and violent 
movement, a twist or a strain. The ligaments of the joint 
are subjected to traction or are lacerated and there is hemor- 
rhage into the joint and the surrounding soft parts. 

The knee, wrist, elbow and ankle are the joints most fre- 
quently sprained. In severe sprains the ligaments may be 
completely torn, the cartilage of the joint may be injured, 
the surrounding muscles may be stretched and there may be a 
hemorrhage into the joint. 

A portion of the bone or cartilage may be torn away by 
the attached muscle or ligament. This is known as a " sprain 
fracture." 

Symptoms. — The symptoms of a sprain are well known. 
A severe sprain is accompanied by great pain. There is often 
nausea, the patient may faint. The part immediately swells. 
Movement of the joint is impaired and is accompanied by 
intense pain. 

If blood vessels near the surface are ruptured, the parts may 
become black and blue in a few hours, but if the deeper blood 
vessels are ruptured the discoloration of the skin may not 
appear for a day or even for several days. 

Treatment. — It is often difficult to diagnose a sprain from a 
fracture. In many cases positive diagnosis can be made only 
by an X-ray. A physician must, therefore, be consulted 
whenever possible. 

Many serious joint troubles, subsequent disease of joints, 
permanently weak joints, and partial or complete stiffness 
of joints, may follow neglected sprains. 

Flat foot may follow a neglected sprained ankle. 

122 



SPRAINS AND DISLOCATIONS 123 

The first treatment of a sprain should be directed toward 
the arrest of the effusion and hemorrhage; this is best accom- 
plished by pressure and cold applications, aided in some joints 
by elevation and rest. If the ankle or the knee be sprained, 
the limb can be elevated upon one or two pillows. If the 
wrist, elbow or shoulder is sprained, the arm should be placed 
in a sling. 

The joint should be wrapped with cloths or absorbent cotton 
wrung out in ice water and a gauze bandage applied. The 
cold can be maintained by the use of an ice bag. A wet com- 
press of epsom salts may be used. This compress is covered 
with rubber dam. The compress is moistened every two or 
three hours. If a solution of epsom salts is used as an evapo- 
rating lotion and not as a cold compress, the part should not be 
covered with a rubber dam but should remain uncovered so 
as to allow rapid evaporation of the solution. 

Care should be taken in the application of the wet bandage, 
to allow for shrinking. Instead of using ice cloths, an evapo- 
rating lotion such as lead water and laudanum or alcohol 
may be used. These solutions by their rapid evaporation 
produce cold. 

The cold applications should be used continued for six to 
twenty-four hours, depending upon the rapidity with which the 
acute swelling subsides. If the pain persists under the use of 
cold, use hot applications, or emerse the joint frequently in hot 
water. If the sprain be a severe one, after the acute swelling 
has subsided, the joint should be immobilized by the use of 
plaster of paris or b}- a splint. 

Complete rest should be maintained for one or two weeks, 
depending upon the severity- of the sprain. The splint or cast 
may be removed each day and the part massaged. The 
strokes of massage should be made toward the body. 

In sprains of a lesser degree, after twenty-four or forty- 
eight hours the joint may be used in moderation. 

If the ankle is sprained a Gibney dressing is one of the 
best methods of supporting the joint. It is the dressing which 
is used for football players which enables them to return to the 
game so soon after injury. It is applied as follows: 

Gibney Dressing. — Shave the leg from the middle of the 



124 TREATMENT OF EMERGENCIES 

calf to the foot. Cut six pieces of zinc oxide adhesive plaster, 
one inch wide and about twenty-four inches long. Cut six 
pieces of zinc oxide adhesive plaster one inch wide, and about 
twelve to fifteen inches long, depending on the length of the 
foot. 

Take a strip, one of the twenty-four inch strips, and place 
the center of the strip under the heel, as near the point of the 




Fig. 81. — First strip of adhesive plaster for Gibney dressing. 

heel as possible, and carry the ends of the strip up along the 
back of the calf. 

Next take one of the twelve-inch strips and place the 
center of the strip on the back of the heel, near its sole and 
carry the ends of the strip forward along either side of the 
foot (see Fig. 81) for first two strips. 



SPRAINS AND DISLOCATIONS 125 

These strips now alternate, the long ones running up the 
calf and gradually approaching the front of the leg, each 
strip overlapping one-half of its predecessor. The short strips 
ascend upon the foot, each one overlapping its predecessor. 

A space of at least one inch should be left free of adhesive 




Fig. 82. — Gibney dressing for sprained ankle 



on the front of the foot to prevent swelling and pain in the 
ball of the foot and the toes (see Fig. 82). 

The adhesive strips must lie smoothly against the skin and 
not crease nor wrinkle the skin. 

After the Gibney dressing is completed a two-inch roller 
bandage may be applied until the adhesive plaster is firmly 
adherent. 



126 TREATMENT OF EMERGENCIES 

When it is desired to remove the adhesive plaster from the 
skin,' saturate the plaster well with ether, alcohol, or turpen- 
tine or soak the whole part in hot water. 

After the plaster has been removed wash the part with 
soap and warm water, dry thoroughly and powder with 
talcum powder. 




Fig. 83. — Adhesive plaster dressing (Indian Puzzle) for sprained knee. 

A sprained knee may be strapped with adhesive plaster as 
shown in Fig. 83. The leg, if hairy, should at first be shaved. 

Some advocate immediate massage following a sprain. 
The method causes severe pain and against it are some ob- 
jections of a technical nature. 



SPRAINS AND DISLOCATIONS 127 

Strains. — A muscular strain is the stretching or partial 
tearing of a muscle. If the force is sufficient, or if the part 
has been weakened by previous disease, the muscle may be 
completely ruptured. Tendons and ligaments, being inelastic, 
can not stretch but may be torn partially or completely. 

Strains of the muscles of the shoulder, of the biceps, of the 
back, of the thigh and calf of the leg, are common. 

The "glass arm" of the baseball player is a strain of one of 
the muscles of the arm. "Lawn tennis" arm is the strain of 
a muscle of the arm. 

Symptoms. — The symptoms of a strain are severe and 
immediate pain in the part injured, pain being greatly aggra- 




Fig. 84. — Method of flexing knee across pillows to relax all muscles and 

ligaments. 

vated by voluntary motion of the part. There is tenderness 
over the affected muscles. There may be complete inability 
to move the part at all. If the patient makes no attempt to 
either aid or hinder, the surgeon can usually move the part 
with the production of little or no pain. 

Treatment. — For slight strains a supporting bandage or 
strapping the part with adhesive plaster will usually give relief. 

In severe strains the part must be put at complete rest 
and kept in a position which insures relaxation of the injured 
muscles. 

If the muscles of the shoulder, upper arm or forearm be 
strained, the arm should be placed in a sling. If the muscles 
of the thigh or leg be strained, the patient should be put to 
bed and the knee be flexed across a pillow (see Fig. 84). 



128 TREATMENT OF EMERGENCIES 

Hot applications give relief. When the acute pain has 
subsided, the part should be massaged. If the muscles of the 
back are strained, the patient should rest in bed. A mustard 




Fig. 85. — Method of strapping strain or sprain of back. 

plaster should be applied to the back. When the acute pain 
has subsided, massage should be employed. Before the 
patient is allowed to leave his bed, the back should be strapped 
with adhesive plaster as shown in Fig. 85. 



SPRAINS AND DISLOCATIONS 129 

DISLOCATIONS 

A dislocation is an injury to a joint, in which the articular 
surfaces of the bones forming the joint have slipped and 
remained out of place. 

Dislocations are always associated with some injury to the 
ligaments of the joint. 

When a person has the same joint frequently dislocated, the 
ligaments and the capsule of the joint become stretched. 
This renders the joint prone to dislocation from even trivial 
force. 

There are two forms of dislocation: a simple location, in 
which there is no wound leading to the injured joint; and a 
compound dislocation, in which there is a wound leading from 
the surface to the injured joint. 

A dislocation may be complicated by a fracture of one or 
both of the bones, by severe injury to the soft tissues around 
the joint or by injury to nearby blood vessels or nerves. 

A dislocation may be caused by direct violence, as by a fall, 
or by muscular effort, as by throwing a stone. 

General Symptoms. — The pain is usually sickening or 
nauseating in character. If the injured joint is compared 
with the corresponding joint on the uninjured side, it will be 
seen that the injured joint is deformed. There may be 
swelling of the soft parts around the injured joint. The 
movements of the joint will be limited because of spasm 
of the muscles and because the bone can not move in its abnor- 
mal situation. 

There is great pain on any attempt to move a dislocated 
limb, as, by movements, surrounding soft parts and nerves 
are pressed upon by the end of the dislocated bone. 

Treatment of Simple Dislocations. — If shock exists, it must 
be treated by appropriate means (see page 109). The treat- 
ment of the dislocation is prompt reduction, that is prompt 
restoration of the bones to their normal relation. 

This is often difficult and sometimes impossible and the 
attempt to a greater or less degree endangers the nerves and 
blood vessels around the joint. 

It is sometimes difficult to recognize whether the injury 

9 



130 TREATMENT OF EMERGENCIES 

is a dislocation or a fracture, or a combination of the two. 
To be certain that a bone is fractured as well as dislocated, 
often tries the skill of the most experienced surgeon. 

It may, therefore, be understood that the layman should 
never attempt to reduce a dislocation, if surgical assistance can 
be had, even if a wait of many hours is necessary before a 
surgeon can be obtained. The longer the patient waits, the 
harder it is to reduce the dislocation, but the difficulty which 
results from delay is less perilous than the bungling attempt 
of unskilled hands. 

It is often necessary for a physician to administer ether or 
chloroform to relax the muscle spasm before the reduction 
of a dislocation of a large joint can be accomplished. Anes- 
thesia is usually necessary to reduce the dislocation if the 
dislocation is several days old. 

While waiting for medical aid, the limb should be put 
at rest in the position most comfortable to the patient. 

In case of the shoulder, elbow or wrist, the limb should be 
rested in a sling. In the case of the hip, knee or ankle, the 
patient should be put to bed and the limb should be placed in 
a splint as shown in Fig. 41. 

Cloths wrung out in ice water, an ice bag or lead water and 
laudanum placed over the joint will help to minimize the pain 
and swelling. 

Treatment of Compound Dislocations. — The treatment of 
a compound dislocation is twofold: first, the treatment of 
the wound; secondly, the fixation of the injured part. 

After hemorrhage has been controlled, place sterile gauze 
or a piece of surgically clean material over the wound and 
immobilize the part and await the arrival of the doctor. 

DISLOCATIONS OF SPECIAL PARTS 

All dislocations with the possible exception of the jaw and 
fingers should be reduced by a physician, even if it is necessary 
to wait several days. 

Dislocation of the Lower Jaw. — There is little danger in 
anyone attempting to reduce a dislocation of the jaw. This 



SPRAINS AND DISLOCATIONS 



131 



dislocation usually occurs as a result of a blow on the jaw, 
when the mouth is open or of yawning, vomiting or laughing or 
occasionally of some wager, as the placing of a billiard ball or 
whole apple in the mouth. 

The dislocation is painful as the mouth is held widely open 
and rigid. The victim is unable to articulate, and the saliva 
dribbles over the gums. 

Treatment. — The patient's head is placed against the back 
of the chair. The operator stands in front of the patient 
and places his thumbs (which have been wrapped to prevent 
them from being bitten) upon the last teeth of the lower jaw, 
the free fingers grasping the chin (see Fig. 86). 




Fig. 86. — Method of reducing a dislocation of the jaw (Makins). 



Pressure downward and backward is now made with the 
thumbs and using the thumbs as levers upward pressure is 
made on the chin with the fingers until the jaw slips back into 
place. 

Another method advocated is as follows: 

The operator stands behind the patient with the patient's 
head against the operator's chest. The operator now places 
his right thumb (which has been wrapped) far back in the 
patient's mouth, between the last molar teeth on the right 
side of the jaw and grasps the chin with the left hand (Fig. 87). 



132 TREATMENT OF EMERGENCIES 

By making pressure downward and backward, the right 
hand readily forces the one side of the jaw into place. Then 
the operator places his left thumb in the left side of . the 
patient's mouth and grasps the chin with the right hand. The 
left side of the jaw is then forced into place. 

After the dislocation has been reduced, a jaw bandage 
must be worn for two weeks. It is advisable to give liquid diet 
for the first week of the accident. 




Fig. 87. — Method of reducing dislocation of jaw. 

Dislocation of the Shoulder. — Dislocation of the shoulder 
is one of the most common dislocations. It usually results 
from falling upon the palm of the hand, with the arm out- 
stretched. 

It may often be recognized by the flat appearance of the 
injured shoulder, as compared with the rounded appearance 
of the normal shoulder, by the protrusion of the elbow away 
from the side, by rigidity of the shoulder joint, by the fact 
that the hand of the injured limb can not be placed upon the 
opposite shoulder, while the elbow is in contact with the 



SPRAINS AND DISLOCATIONS 133 

chest and by the characteristic attitude assumed by the 
patient, namely, sitting bent toward the injured side and holding 
the elbow of the injured limb in the hand of the sound limb. 

Treatment. — None but a physician should ever attempt to 
reduce a dislocation of the shoulder. The patient should be 
put to bed. The injured arm is kept in the position most com- 
fortable to the patient and an ice bag is placed upon the 
shoulder. If the patient must be transported to the physi- 
cian's office or to a hospital the injured arm should be place* 1 
in a sling. 

Dislocation of the Elbow. — Dislocation of the elbow is not- 
infrequent, it occurs often in children. 

A backward dislocation of one or both bones of the forearm 
is the most common form. 

The cause is usually a fall upon the extended hand. It is 
recognized by the elbow being fixed at a right angle with the 
upper arm. The distance between the bend of the elbow and 
the wrist of the injured arm is much shorter than the same 
distance on the sound arm, there is a marked projection of 
the bone back of the elbow and a fossa or space above this 
projection. 

Treatment. — None but a physician should ever attempt to 
reduce a dislocation of the elbow. The arm should be placed 
at rest in a position most comfortable to the patient until a 
physician can properly reduce the dislocation. 

Dislocation of the Hip. — Dislocation of the hip is not com- 
mon. The cause of the dislocation is usually a fall upon the 
foot or upon the knee, or a blow from an object striking the 
back while the patient is in a bending posture. 

The head of the bone may be dislocated either forward or 
backward. The backward dislocation is the most frequent. 

The backward dislocation may be recognized by the rigidity 
of the muscles of the joint, by the shortening of the limb, the 
foot being turned inward and the thigh being drawn toward 
or across the opposite thigh. 

The forward dislocation may be recognized by the rigidity 
of the muscles around the joint, the partial flexion of the 
thigh, the foot being turned outward and the thigh being 
held away from the midline. 



134 TREATMENT OF EMERGENCIES 

Treatment. — None but a physician should attempt to re- 
duce a dislocated hip. 

The best first aid treatment is to place the patient fiat on 
the back and support the injured leg on pillows which are 
placed under the knee in a manner most comfortable to the 
patient. 




Fig. 88. — Levis's splint for reducing dislocation of phalanges. 

If the patient must be transported to a hospital, a splint 
should be applied. The thigh and leg should be splinted as 
for fracture of the thigh (see page 54). 

Dislocation of the Fingers. — Dislocation of a finger is a 
common injury. The injury is common among baseball 
players. The dislocation is usually backward. It is not a 
difficult condition to recognize. 

Treatment. — Make strong traction on the finger and manipu- 
late the dislocation into place. 




— Levis's splint applied. 



In an obstinate case, the apparatus shown in Figs. 88 and 89 
may be employed. 

After the dislocation has been reduced the finger should be 
kept in a splint for one week. 

Dislocation of the Thumb. — The dislocation of the second 
joint of the thumb, as shown in Fig. 90, is often difficult to 
reduce, because the head of one of the bones becomes caught 
between two muscles. 



SPRAINS AND DISLOCATIONS 135 

Treatment. — Bend the thumb slowly backward, then make 
traction, at the same time attempting to push the bone into 
place. It may be necessary to use the appliance shown in 
Fig. 88 to make the proper manipulation. 




Fi<;. 90. — Backward dislocation of first phalanx of thumb (Helferich . 

Dislocation of the Toes. — A dislocated toe is a rare injury. 

The great toe is the one most likely to be dislocate* 1. 

The dislocation is reduced by making traction on the toe. 
The patient should rest the foot for two weeks. 



CHAPTER V 
BURNS AND SCALDS 

A burn is caused by contact with actual flame or with a 
hot solid object. Scalds are caused by contact with heated 
fluids such as boiling water, or heated vapor such as steam. 
The action of dry heat and moist heat upon the tissues is 
nearly identical. 

A burn may be caused by concentrated chemicals such as 
carbolic or nitric acid. A hot water bag may cause a burn. 
Care should be taken with the use of a hot water bag, especi- 
ally when the patient is unconscious, or paralyzed, and there- 
fore unable to complain of the excessive heat. Scalds are 
usually more extensive than burns, unless the clothing takes 
fire, because the clothing tends to diffuse the fluid over a great 
area. Burns are divided into six degrees. A burn of the 
first degree is a superficial burn, which only, reddens the 
skin. The skin may peel later. A burn of the second 
degree causes an inflammation of the skin with subsequent 
formation of blisters. A burn of the third degree partially 
destroys the skin, but the entire thickness of the skin is not 
burned through. A burn of the fourth degree destroys the 
entire skin down to the underlying fat. A burn of the fifth 
degree destroys the skin and fat and exposes the muscles. 
In a burn of the sixth degree, the whole part is charred or 
burned away. The symptoms of a burn are both local and 
constitutional. The local symptoms vary with the depth of 
the burn from the mere redness of the skin, to the destruction 
of the skin and muscles, or to complete carbonization of the 
part. A burn involving only the upper layers of the skin, 
leaving the ends of the nerves of the skin exposed, is more pain- 
ful than a burn which destroys all of the layers of the skin, and 
with them the nerve endings. For this reason a superficial 
burn may be more painful than a deep burn. A deep burn is 

136 



BURNS AND SCALDS 



137 



certain to be accompanied by severe shock and shock lessens 
appreciation of pain. The constitutional symptoms vary 
with the depth of the burn and the amount of the body surface 
burned. A burn of the first degree over one-half or two-thirds 
of the body is more dangerous than a deep burn over a smaller 
area. In the burn over an extensive area not only is shock 
great, but the skin is unable to throw off secretions which 
should be eliminated by the sweat glands. These secretions 




Fig. 91. — Burns of second and third degree. 

remain in the system or are thrown off by the kidneys. The 
kidneys, because of the extra work in throwing off the poison- 
ous secretions, may become inflamed. Poison is absorbed 
from the burned tissues and carried through the body. Burns 
on the abdomen and chest are more serious than those on the 
extremities. Following a burn the internal organs, as the 
liver, kidneys, lungs, or the brain, may become the seat of a 
severe or even fatal congestion or inflammation. 



138 



TREATMENT OF EMERGENCIES 



Pneumonia is not uncommon after a burn. Suppression 
of urine is not uncommon. Vomiting after a burn is a bad 
sign. Children, the aged and alcoholics stand burns very 
poorly. 

Treatment. — The treatment of a burn is local and constitu- 
tional. The local treatment depends somewhat on the depth 
and extent of the area burned. 

For a burn of the first degree such household remedies as 
baking soda, cold cream or vaseline give relief. A solution of 




Fig. 92. — Scald of second degree of left upper extremity (Bryan). 

baking soda may be made in the strength of one teaspoonful 
of the soda to eight teaspoonfuls of water. Cloths saturated 
with this solution are placed over the burned area. Any 
blisters must be opened with a needle. The needle must first 
be sterilized by passing it through an alcohol flame. Carron 
oil is a preparation of linseed oil and lime water. It was 
formerly carried in the emergency kits of the Philadelphia 
Fire Department to treat burns. It is a dirty preparation 
and so many burns treated with it became infected that its 
use has been discontinued. Picric acid gauze is now used. 
The gauze is saturated with a 0.5 per cent, solution of picric 
acid. It is contained in a sterile package. The only dis- 



BURNS AND SCALDS 139 

advantage of this picric acid treatment is that, if an extensive 
burn is dressed with it, picric acid poisoning may ensue. 

The symptoms of picric acid poisoning are marked yellow- 
ness of the skin, dark-colored urine, fever and diarrhea. 

Boric acid ointment is a soothing and satisfactory dressing 
for burns. Zinc ointment or an ointment of equal parts of 
boric acid and zinc ointment are excellent applications for 
burns. 

An extensive burn is best treated with applications of 
sterile gauze soaked with salt solution. The gauze must be 
kept constantly wet with the salt solution. If the fingers or 
toes are burned, a piece of gauze or lint must be placed in 
each interdigital space, otherwise as the burn heals the digits 
will adhere to each other and become webbed. Associated 
shock must be treated (see page 109). One of the best ways 
to handle a severe burn with great shock is to place the 
victim in a tub of warm water. The water should be at a 
temperature of 100°. This not only tends to maintain the 
body heat, but also makes less difficult the removal of the 
clothing. In cases when the clothing must be removed from 
the burned parts, the part should first be soaked with peroxide 1 
of hydrogen. Always cut the clothing. Never attempt to 
remove a coat, shirt or trousers in the ordinary way, when to do 
so it would be necessary to drag it from a burned or scalded 
area. Never expose a large area of an extensive burn to the 
air. Cut the clothing from a part of the burned area, dress 
this part, then cut more clothing and dress the part exposed, 
and so on until the whole burn is dressed. The same principle 
must be applied, when re-dressing a burn. Following the 
infliction of a burn and its dressing, give plenty of water to 
drink. This procedure helps to flush the kidneys. If the 
patient is confined to bed, change his position frequently so as 
to prevent if possible congestion of the lungs from lying too 
long in one position. 

At the present time in France burns are being treated with 
a preparation known as ambrine. The burned area is thor- 
oughly cleansed by gently sponging with salt solution or boric 
acid and is then dried with superheated air. The ambrine 
having been melted over a water bath is then applied to the 



140 TREATMENT OF EMERGENCIES 

burned area in an atomizer or with a small camel's hair paint 
brush. A thin webbing or layer of cotton is then placed over 
the burned area and the cotton is sealed over the burn with 
application of additional ambrine. 

I have used this preparation in only a few cases. In these 
cases the treatment has been very satisfactory. Fig. 93 
shows a burn of the face treated with ambrine. Ambrine is at 
present difficult to obtain in this country. 




Fig. 93. — Burn of the face treated with ambrine. 

The following formula renders a very satisfactory substitute 
for ambrine. The technique for its use is the same as for 
ambrine. 

1$ Paraffine wax, 5 xvi ; 

White wax (Leonhard's sun bleached wax), gl; 

Resin cerate, § ss. 

The paraffine is melted on a water bath. The white wax and 
resin cerate are mixed and melted. The combination of the 



BURNS AND SCALDS 141 

two latter is then added to the melted paraffine and the mixture 
is stirred well. 

These waxes melt at a low temperature and should not be 
brought to the boiling point as it will crumble when applied to 
the burn. 

Burns by Chemicals. — If strong acid comes into contact 
with the skin it will cause a burn. Sulphuric acid or oil of 
vitriol is sometimes thrown into the victim's face by one who is 
seeking revenge. Carbolic acid or creosote is not infrequently 
used for medical purposes in too strong a solution, thus causing 
a burn. Acetic and nitric acid may also cause burns. Oxalic 
acid and hydrochloric acid do not burn the skin. Sulphuric 
acid will cause a black discoloration with any part with which 
it comes into contact. Nitric acid stains yellow. Carbolic 
acid stains the parts white. Acetic acid produces redness of 
the skin, blistering and finally superficial sloughing. 

Treatment. — The action of the acid should be countered by 
at once pouring over the burned area an alkali such as am- 
monia water, limewater, or a solution of baking soda and 
water. If the burn has been caused by carbolic acid, or by 
creosote, bathe the part freely with alcohol or whiskey. After 
the action of the acid has been countered, dress the part with 
sweet oil or with cosmoline. Burns caused by concentrated 
alkalies, such as ammonia, caustic potash, or caustic soda, are 
neutralized by washing the part with a dilute acid as vinegar 
or lemon juice. 

Burns About the Mouth and Throat. — For chemical burns 
of the mouth see also " Poison," page 310. Burns of the 
mouth and throat may follow the inhalation of hot steam, of 
actual flame, or by drinking an excessively hot fluid. A 
child may attempt to drink from the spout of a tea kettle. 
There is great pain. The tongue and mucous membrane of 
the cheeks, and throat swell rapidly. Blisters form. Breath- 
ing and swallowing may be difficult. 

Edema or sudden swelling of the glottis (the valve of the 
windpipe) may occur (see page 150). 

Treatment. — Existing shock must be treated. Puncture 
any blisters with a sterile needle. Give ice to suck. Wash 
the mouth out frequently with boric acid solution. 



142 TREATMENT OF EMERGENCIES 

Burns About the Eyes. — Firemen not infrequently suffer 
from burns of the eyelids and occasionally from burns of the 
conjunctiva and cornea. Often the cornea is burned with .a 
hot cinder. If the lids are burned, an application of cosmoline 
will give relief. Severe swelling of the lids often follows such 
a burn. This is best treated by ice compresses. Pieces of 
lint are cut about the size of a silver dollar, are laid upon a 
piece of ice or are soaked in ice water; these are placed upon 
the closed eyelids. As soon as this piece becomes warm, it is 
replaced upon the ice and a fresh piece is put upon the eyelids. 

If the conjunctiva or cornea is burned, an eye specialist 
should be consulted as early as possible. Examine under 
both eyelids and remove any foreign body (see page 191). 
Wash the eye with boric acid solution, and then apply three or 
four drops of sweet oil. Place a pledget of cotton over the eye 
and a bandage to hold the cotton in place, then send the case 
at once to an eye specialist. The surgeon in authority on the 
fire ground should see that no cocaine is used in the eye of any 
fireman who is working at the fire. The application of cocaine 
to remove cinders on such occasions is not infrequent. A 
fireman having cocaine in his eye returns to the fire. The 
eye is insensitive and may be burned or may receive another 
cinder which will cause no pain, consequently the eye will 
become badly ulcerated and infected. Cocaine also causes a 
secondary congestion of the eye. Cocaine partially dilates 
the pupil and the fireman can not see as clearly as he should. 
This is one of the most important points of accident work. 
All ambulance surgeons should be instructed not to use co- 
caine under such circumstances or if cocaine must be used the 
fireman is not to return to the fire. Lye burns are not in- 
frequent. Pain is intense. Do not attempt to wipe lye from 
the eyelid, but flush the whole eye with boric acid solution. 
If an acid gets into the eye, thoroughly irrigate the eye with 
salt solution, limewater or with a solution of baking soda, then 
introduce into the eye three or four drops of sweet oil. 



CHAPTER VI 

THE EFFECTS OF HEAT AND COLD UPON THE 
TISSUES 

SUNBURN AND FROST BITES 

Sunburn. — Sunburn may only simulate a burn of the first 
degree, causing a simple reddening of the skin, or it may 
cause actual blistering of the skfn. There may be intense 
pain and swelling of the part. If there is only redness of the 
skin with burning sensation, an application of alcohol is 
soothing and cooling. If blisters form, they must be opened 
with a sterile needle and the fluid released. An application of 
cosmoline, boric acid ointment, or zinc ointment may then 
be applied. 

Occasionally one who has a very tender skin ma}' suffer 
severely with sunburn. There may be fever. Water should 
be freely administered by mouth. The eyelids may be 
burned, swell and close the eyes. Cold compresses to the 
eyelids will relieve the swelling. 

Chilblain. —When a part of the body is exposed to the cold, 
the blood vessels contract causing the part to become numb. 
The blood vessels react and dilate. The part becomes red- 
dened and swollen, causing burning and aching. If the 
blood vessels then regain their normal strength, they will 
contract to their normal caliber. If the circulation of the 
blood is poor, the vessels do not contract to their normal 
caliber and the swelling and redness may return when the 
part is again subjected to slight cold. This condition is 
known as " chilblain." 

Chilblain usually affects the fingers, toes, ears, or the nose. 
When the part becomes congested, it itches and stings. 
Occasionally blisters form. 

Treatment. — A person w r ho is subject to chilblain should use 
special care during cold weather. If the toes are the affected 
parts, woolen socks should be worn. Avoid tight shoes. The 
hands or ears must be well protected if affected by chilblain. 

143 



144 TREATMENT OF EMERGENCIES 

Caution the person not to warm the affected part in front of 
a fire after being out in the cold. If the fingers or toes are 
subject to chilblain, bathe them daily in cold water, wipe 
dry with flannel and apply a solution of 1 part of iodine and 
2 parts of soap liniment. The Esquimaux and Indians use 
oil of turpentine. This may be diluted with an equal part 
of olive oil. To relieve itching apply an ointment of one 
dram of powdered camphor to four ounces of cosmoline. 

Frost Bite. — A part which is frost-bitten becomes purple and 
mottled. If badly frozen, the part will become white and 
numb. Blisters may form and gangrene may follow. Gan- 
grene is especially likely to occur, if the frost-bitten area is 
suddenly brought to a warm atmosphere, causing a sudden 
congestion of the part. 

Treatment. — The treatment of a frost bite is primarily to 
bring the temperature of frost-bitten area back to normal 
gradually. The victim of a frost bite should never be brought 
suddenly into a warm atmosphere. If possible, rub the part 
with snow. If there is no snow, submerge the part in ice 
water, and gradually increase the temperature of the water. 
Apply friction to the part while it is submerged. When the 
circulation of the frost-bitten area has been restored, rub the 
part with vaseline and wrap with cotton. If blisters form, 
they should be opened with a sterile needle. A part which has 
once been frost-bitten is subject to subsequent frost bites. 
Alcoholics fall easy victims to frost bites. Their circulation 
is below par. Alcoholic beverages on a cold day give an arti- 
ficial sense of warmth. Alcohol lowers body heat. The 
vessels of the surface of the skin dilate. The sense of warmth 
is only temporary. The dilatation of the vessels tends to con- 
gestion and thus makes a ready field for frost bites. Warn 
firemen of the dangers of taking brandy or whiskey in cold 
weather. They are often offered such beverages by those who 
do not realize the subsequent danger of frost bite. Hot coffee 
and hot tea are the best beverages to give the firemen. 

If gangrene follows frost bite, dress the gangrenous area 
with an antiseptic solution such as boric acid solution, acetate 
of aluminium, or alcohol. A physician cuts the gangrenous 
area away after a line of demarcation has formed. 



CHAPTER VII 
ASPHYXIATION 

Asphyxiation may be due to the inhalation of smoke. 
Smoke impregnated with fumes of ammonia, nitric acid or 
illuminating gas is highly dangerous. Smoke where lacquer, 
bronze paint, or aluminum paint is used or made, may be 
impregnated with banana oil (amyl acetate). This also is 
highly dangerous. Smoke from burning pepper or spices 
is highly irritating. Hot smoke is far worse than cool smoke. 
It is a fact that firemen after years of service will become 
accustomed to smoke, and some of the older firemen can re- 
main in an atmosphere laden with smoke for an astonishing 
length of time. The best air in a smoky room is always close 
to the floor. Around the nozzle of a hose pipe there is fresh 
air which is carried in with the water. Firemen who have 
been in active service a long time can often taste illuminating 
gas in a smoky atmosphere. It is not always easy to dis- 
tinguish, and often is not discovered until its effect is shown 
upon the men. Smoke from burning lumber, rags, barrel 
staves, burned paper, spices and wet hay are hard to tolerate. 
Smoke from oils is not so hard to endure. 

Smoke impregnated with ammonia will cause strangulation 
and death in a few minutes. Ammonia is used in the process 
of making ice, in cold-storage plants, in restaurants, in dye 
houses, breweries and in wool-washing establishments. Smoke 
from burning celluloid is highly dangerous because of the 
presence of hydrocyanic acid. 

Smoke can be better tolerated when a high wind is blowing 
which occasionally causes the smoke to rise and allow a 
breathing space, than on a humid day when there is no wind 
and the smoke settles close to the ground. Subcellar fires 
are always dangerous from a medical standpoint because of 
the many resulting cases of smoke asphyxia. 
10 145 



146 TREATMENT OF EMERGENCIES 

There are three stages of smoke asphyxia. In the first 
stage, the victim is conscious. In the second stage, the victim 
is unconscious, but is still breathing. In the third stage,, the 
victim is unconscious and is not breathing. In the first stage 
of smoke, a fireman staggers out of the building, reeling often 
like a drunken man. A fireman in such a condition may 
be accused of being drunk. He coughs and tries to vomit. 
His eyes are red and burn intensely. He has a severe throb- 
bing headache and his legs are weak and incoordinate. Often 
he fights like a drunken man when an attempt is made to get 
him away from the fire. Such a man should be removed from 
the smoky atmosphere. The clothing about the waist and 
neck should be loosened; a blanket should then be thrown 
around him. One of several preparations may be given. 
Weiss beer is efficient. If this can not be obtained, a seidlitz 
powder or a dessertspoonful of effervescent sodium phosphate 
in a tumbler of water may be given. A teaspoonful of aro- 
matic spirits of ammonia or a teaspoonful of Hoffman's anodyne 
in a half a glass of water will often give relief. Vomiting 
tends to bring up the gases and mucus from the lungs and 
stomach. It is purgation of the bronchial tubes. Keep the 
fireman out of the smoky atmosphere until he has regained 
the strength of his legs and his equilibrium. If his condi- 
tion becomes aggravated, he should be sent to a hospital. 
Should he have a chill, he should at once be sent to a hospital. 
To send him again into smoke after he has had a chill will 
inevitably be followed by another knockout. A fireman 
twice overcome with smoke at the same fire should be sent 
to a hospital. A fireman who is unsteady on his legs and 
who is only half conscious as to what he is doing, is of no help 
to his company and is in great personal danger as he may fall 
in the building and be lost or may walk off a roof or stagger 
into an open elevator shaft. A fireman should keep near the 
hose of his company and when he moves, should crawl along 
it. He is then in no danger of being lost and should he become 
dizzy or weak, he can follow the hose out of the building or if 
he falls unconscious will soon be found by a comrade. 

At a smoky fire, a company usually works in relays. Two 
or three members of the company handle the nozzle for a 



ASPHYXIATION 147 

short time; they are then relieved by two or three others who 
are fresh. 

If it is necessary to remove a fireman to a hospital, he 
should be taken to the nearest hospital irrespective of which 
ambulance is being used. When the nearest hospital, because 
of overcrowding, can no longer care promptly for such firemen, 
they should then be sent to the next nearest hospital. The 
system is a poor one which allows a hospital ambulance to take 
firemen to its own hospital only, unless that be the nearest 
hospital to the fire ground. Ambulance surgeons are often 
overzealous in trying to make a record for their hospital, and 
often do so regardless of the danger to or welfare of the fireman. 

Ambulances or patrol wagons should be stationed at dif- 
ferent points as close to the fire as is practical and it should 
always be seen that they have a clear street for hasty exit. 
When a fireman becomes unconscious, he is carried to the 
street. The method for carrying an unconscious person is 
fully described on page 277. 

He is quickly transferred to a stretcher and carried to a 
spot where the atmosphere is free from smoke. If the fire- 
man is in the second stage of smoke, that is, if he is unconscious, 
but still breathing, he should be carried out of the smoky 
atmosphere, should be laid upon a stretcher and covered with 
a blanket. His mouth should be examined and all foreign 
bodies, such as false teeth, tobacco, etc., should be removed. 
Oxygen is then administered. All ambulances, patrol wagons 
and fire trucks should carry a tank of oxygen. If he does not 
regain consciousness quickly, he should be taken to the 
nearest hospital. Oxygen should be given him on the way 
to the hospital. Never try to pour any liquid down the throat 
of anyone who is unconscious. Never give nor allow to be 
given anything by mouth to a person until he or she is fully 
conscious and is well able to swallow. If fluid is poured down 
the throat of one who is unconscious, it ma}' go into the lungs 
as well as into the stomach and cause death from suffocation. 
This caution is mentioned with emphasis as such a procedure 
is not infrequently attempted. 

When the victim is able to swallow, a stimulant may be 
given. Aromatic spirits of ammonia, Hoffman's anodyne, or 



148 TREATMENT OF EMERGENCIES 

best of all hot coffee, should be administered. Whiskey is 
not a good remedy for smoke cases. It tends to prolong the 
nausea and aggravate the headache. A fireman who is a 
whiskey drinker stands 'smoke poorly. He is a danger to 
himself as well as to the others working with him on the fire 
ground. Ambulance surgeons should never give whiskey 
to firemen. If a fireman is brought from a building in the 
third stage of smoke, and is not breathing, every second 
counts. Such a case is the test of the fire surgeon, and 
a test of whether or not those under him have been properly 
instructed in first aid. The victim is cyanotic. 

While artificial respiration is being given, he should be 
covered to the waist with a blanket. Place a blanket for him 
to lie upon. Order the stretcher nearby so that as soon as 
respiration has been established, he may be removed to the 
nearest hospital. Never allow a person who is not breath- 
ing to be placed in an ambulance or to be taken to a hospital 
until respiration has been reestablished by artificial means 
and has become deep and regular. The person, who might 
be saved if artificial respiration was started at once, may be lost 
if put in an ambulance to be driven many blocks to a hospital. 
Such a patient should be kept in the hospital for at least 
twenty-four hours. After twenty-four hours he may be 
allowed to go home, provided there is no complication or 
sequelae. Bronchitis or even broncho-pneumonia may ensue. 
Such a case will for a day or two expectorate sputum darkened 
by carbon. The eyes are badly irritated and blue glasses 
must be worn for several days. Headache is relieved by 
means of an ice cap placed upon the head and the administra- 
tion every three or four hours of ten grains of bromide of 
soda. 

For methods of giving artificial respiration (see page 152). 

Smoke Impregnated with Illuminating Gas. — Smoke may 
be impregnated with illuminating gas. Firemen who have 
been in active fire service a number of years can often taste 
illuminating gas when present in smoke. Usually, however, 
illuminating gas is not determined until its effects are shown 
upon the firemen. Illuminating gas, when inhaled, destroys 
the function of the blood cells. This change in the blood 



ASPHYXIATION 149 

cells is a chemical one, and may take some time to be ac- 
complished. A fireman may not feel the effect of the illumi- 
nating gas until he has been in the fresh air for ten or fifteen 
minutes. He may then become dizzy, weak and may fall 
unconscious. Such a case is never asphyxia from smoke 
alone. A fireman overcome with smoke free from illuminating 
gas improves when taken out of the smoky atmosphere. If 
conscious when he reaches the fresh air, he will not subse- 
quently lapse into coma unless the smoke is impregnated with 
illuminating gas. 

As an example, a fireman is working in a smoky building. 
He finds himself becoming giddy, his legs weaken and his 
ears begin to ring. He goes out of the building to the fresh 
air. In five or ten minutes, without further warning, he 
falls unconscious to the sidewalk. Such a case should be 
recognized as due to the action of illuminating gas. 

Treatment. — The victim should be laid upon a blanket. 
A second blanket should be thrown over him. The clothing 
should be loosened. Oxygen should be administered. Oxy- 
gen is most useful in cases of illuminating-gas poisoning. The 
oxygen counteracts the effect of the illuminating gas on the 
blood cells. If the patient is breathing, the tube from the 
oxygen tank is held close to the patient's nose so that he may 
breathe the oxygen. If respirations are suspended, artificial 
respiration must be administered. Either Shafer's method or 
Sylvester's method may be used. While giving artificial 
respiration, the oxygen tube should still be held close to the 
patient's nostrils. 

When the patient is conscious and able to swallow, stimu- 
lants, such as aromatic spirits of ammonia, or coffee, should be 
given. 

If the patient is unconscious, a physician should administer 
strychnine, atropine, or camphorated oil hypodermically. 
When the patient reaches the hospital, an enema of hot coffee 
or hot salt solution should be given. 

A case of asphyxia from smoke impregnated with illuminat- 
ing gas always requires hospital care. It may become neces- 
sary to give salt solution into a vein or to transfuse blood — 
a procedure which has given excellent results in such cases. 



150 TREATMENT OF EMERGENCIES 

Smoke Impregnated with Fumes of Banana Oil. — Banana 
oil is the acetate of amyl. It is used for the purpose of var- 
nishing metals. 

The effect of the fumes of burning banana oil upon an indi- 
vidual is the same as that of illuminating gas. Its action 
may be latent, that is, the effect may not be felt until after 
the individual has been out in the fresh air for several minutes. 
As an example, at a recent fire in a bicycle establishment, 
where banana oil was used extensively, the fire was confined 
to the cellar, and the firemen were working in the cellar in 
relays. Two of the firemen came out of the cellar and went 
into a room free from all smoke. They were sitting on a 
table when, without warning, both suddenly lurched forward 
and fell to the floor. Other firemen were soon overcome 
in like manner. It was thought at first that the men were 
overcome with illuminating gas. The gas had been turned 
off from the street main. It was then found that there was 
a large amount of banana oil in the building, and the men were 
overcome by its fumes. 

Treatment. — The treatment is the same as that for smoke 
impregnated with illuminating gas. 

Smoke Impregnated with the Fumes of Ammonia. — Not 
infrequently at fires in cold-storage plants, carboys of am- 
monia explode. The ammonia is used in the process of mak- 
ing ice. It is encountered in breweries, ice factories, hotels, 
restaurants, wool-washing establishments and dye houses. 
When smoke becomes impregnated with ammonia fumes, it 
is highly irritating and extremely dangerous. The chief 
danger is sudden death from edema of the lungs or rapid swell- 
ing of the glottis. The glottis is a valve which is lined with 
mucous membrane. When a person swallows, this valve 
closes over the windpipe to keep food from entering the lungs. 
When an irritating fume is inhaled, the mucous membrane, or 
covering membrane of this valve, may swell suddenly and 
shut off the windpipe, thus causing asphyxiation. 

Treatment. — The general rules for the treatment of those 
overcome with smoke must be applied. Whether the victim 
is in the first, second or third stage, however, a piece of gauze 
saturated with vinegar should be held over the face so that 



ASPHYXIATION 151 

the fumes of the vinegar will be inhaled. The vinegar, being 
a dilute form of acetic acid, will tend to overcome the effects 
of the ammonia, which is alkaline. 

A bottle of vinegar should be kept for this purpose in the 
emergency kits of every fire department. 

Edema, or rapid swelling of the glottis, is recognized by the 
cyanosis or blue color of the victim's face, and by the inability 
to get any air into the lungs. This condition requires a physi- 
cian to immediately perform an operation to open the windpipe 
from the neck. The operation is called tracheotomy. A set 
of instruments to correctly perform the operation and a tube 
to put in the windpipe should be part of the emergency kit. 
In an emergency a physician can accomplish this by means of 
a pen knife. 

Smoke Impregnated with Fumes of Acids. -Nitric acid is 
encountered in chemical works, in belt-making establishments 
and in the manufacture of tar products. Sulphuric acid is 
also encountered in chemical works. 

Such smoke is also highly irritating and dangerous. The 
chief danger is the same as that of smoke impregnated with 
ammonia fumes, namely, rapid swelling of the glottis. 

Treatment. — The action of the acid can be overcome by 
holding a piece of gauze, on which is sprinkled aromatic 
spirits of ammonia, over the victim's nose and mouth that 
its fumes may be inhaled. The case is treated according to 
the general rules for treatment of asphyxia. If the glottis 
becomes rapidly swollen, it may be necessary for a physician 
to perform tracheotomy. 

Smoke from Burning Pepper or Other Spices. — Smoke from 
burning pepper and other spices is not only irritating to the 
throat and bronchial tubes but is also very irritating to the 
eyes. Firemen are unable to endure such smoke for any length 
of time. The irritation of the smoke causes coughing and 
vomiting. The eyes burn and water. 

Treatment. — Fresh air is the best means of treatment. 
Weiss beer, sodium phosphate or a seidlitz powder may be 
given. The eyes should be bathed frequently with boric acid 
solution. Cocaine should never be used in the eyes while 
the fireman is on duty at the fire (see page 193). 



152 TREATMENT OF EMERGENCIES 

Illuminating-gas Poisoning. — Poisoning by illuminating 
gas may be either accidental or suicidal. Poisoning for either 
of these reasons is increasing year by year. The illuminating 
gas which is now used is a water gas. It is made by forcing 
steam through hot coals or coke. It contains about 38 per 
cent, of carbon monoxide. Carbon monoxide is the poisonous 
constituent. The carbon monoxide destroys the power of the 
blood cells to carry oxygen to the tissues. 

The symptoms of poisoning by illuminating gas are : throb- 
bing in the head, dizziness, headache and muscular weakness. 
There is no irritation of the nose and throat causing cough, as 
in smoke asphyxia. There may be nausea and vomiting. 
The odor of gas may be detected upon the victim's breath. 

In an advanced case of illuminating-gas poisoning the patient 
is unconscious. The face is purple. There may be frothing 
at the mouth. The patient may have convulsions. 

Treatment. — The treatment must depend somewhat upon 
the patient's condition. If the patient is conscious, stimula- 
tions, such as aromatic spirits of ammonia, hot coffee, whiskey, 
or brandy, should be given. The clothing should be loosened 
and the patient placed in the fresh air. It is always advisable, 
even if the patient is conscious, to administer oxygen, as the 
oxygen tends to overcome the poisonous affect of the carbon 
monoxide in the gas. If the patient is unconscious, the body 
must be kept warm, the clothing loosened and oxygen ad- 
ministered. 

During the period of unconsciousness a physician should 
stimulate with strychnine, atropine, etc. If the patient is 
not breathing, artificial respiration must be administered. 
This may be performed by Shafer's or Sylvester's methods. 
The pulmotor or lungmotor may be used. When the patient 
has reached the hospital, a hot enema of coffee should be given. 
Salt solution should be given into a vein, or blood transfused 
after the patient has been bled. Increasing the circulation 
by massage of the legs and thighs is most beneficial. 

ARTIFICIAL RESPIRATION 

When breathing has been suspended from asphyxia, artificial 
respiration must be given at once. The more common causes 



ASPHYXIATION 1 53 

requiring artificial respiration are cases of drowning, electric 
shock, opium poisoning, and asphyxia from illuminating gas 
or from smoke. 

The two methods most commonly used arc Sylvester's 
method and Shafer's method. 

Any case requiring artificial respiration is necessarily a 
serious one and is associated with shock. The victim must 
be kept warm by placing him between blankets or overcoats. 
The clothing around the neck, chest and waist is loosened. 
The legs should be firmly massaged. 

Before starting artificial respiration, see that the victim's 
mouth is free of foreign bodies, such as false teeth, chewing 
gum, tobacco, etc., and see that the throat is clear of mucus. 

Artificial respiration by either Sylvester's method or the 
Shafer's method is hard manual work. It is very difficult for 
one to administer for more than fifteen minutes at a time. In 
many cases of prolonged asphyxia artificial respiration must, 
therefore, be given in relays, each one administering it about 
fifteen minutes. Neither courage nor hope should be lost, 
even though the patient does not start to breathe after artificial 
respiration has been administered for several minutes, as 
many cases of asphyxia from gas poisoning and opium poison- 
ing have recovered after artificial respiration had been admin- 
istered for a number of hours. 

Sylvester's method is the method usually employed in cases 
of illuminating-gas poisoning, asphyxia from smoke and cases 
of electric shock. It is not the best method to use in cases of 
drowning for reasons hereinafter explained. To give artificial 
respiration by Sylvester's method the patient is turned upon 
his back, and a folded coat or blanket is placed under the chest 
(Fig. 94). The tongue is grasped with the fingers or with 
tongue forceps and is held by means of the forceps or by a 
suture through the tongue. In an emergency a piece of 
string may be tied around the tongue, the tongue pulled for- 
ward and the string tied around the neck. Owing to the 
manipulations to be made it is difficult for a second operator to 
hold the tongue. The suture through the tongue is the best 
method. 

The one who is to administer artificial respiration now kneels 



154 



TREATMENT OF EMERGENCIES 




Fig. 94. — Sylvester's method. Inspiration (Da Costa), 





Fig. 95. — Sylvester's method. Expiration (Da Costa). 



ASPHYXIATION 



155 



at the patient's head and grasps the patient's forearms, mid- 
way between the wrist and elbow. The patient's arms are now 
circumducted outward and upward with traction until the 
patient's arms are perpendicular with his body (see Fig. 94). 
By this procedure the muscles cause expansion of the chest. 
By the expansion of the chest a vacuum is created in the cavity 
which surrounds each lung, and the lungs must necessarily 
expand to fill this vacuum. 

The patient's arms are now brought to the sides of his chest 
as in Fig. 95. Firm pressure is made to force the air out oi the 
lungs. This procedure is repeated fifteen or sixteen times a 
minute. If the operator will count one, two, three, while the 




Fig. 90. — Shafer or prone method. First movement. 



pressure is being made against the patient's chest and again 
count one, two, three, while the victim's arms are held above 
the head, the tendency to hasten the procedure will be 
obviated. 

Shaf er's Method or the Prone Method. — The Shafer method 
is the method of choice in cases of drowning. Am T fluid in 
the trachea or lungs will tend to gravitate out of the mouth. 
Another advantage of this method is that the tongue falls 
forward by gravity and does not have to be held. It should 
also be the method used if there has been any injury to the 
arms or shoulders, in which case Sylvester's method can not 
be used. 

For the Shafer method the patient lies on his stomach, his 
face being turned to one side. A folded blanket or coat is 



156 



TREATMENT OF EMERGENCIES 



placed under the chest. The patient's arms are placed above 
the head. The arms in this position tend to put the chest 
muscles on stretch, thus expanding the chest. This position 
also keeps the arms out of the way. 

The operator kneels astride of the patient, and grasps the 
lower part of the thorax with both hands, the fingers being 
parallel with the ribs (see Fig. 98). Firm pressure is now made 
against the thorax. The force exerted should be a squeezing 
inward and upward pressure, rather than a downward pressure. 
While making pressure count one, two, three slowly, then 




Fig. 97. — Shafer or prone method. Second movement. 

suddenly relax the pressure (Fig. 97). The sudden relaxa- 
tion of the pressure is the keynote to the success of giving 
artificial respiration by this method. It will be found when 
the pressure is relaxed suddenly, the patient gives a distinct 
and audible gasp. 

The above procedure should be repeated fifteen or sixteen 
times a minute. 

Howard's Method. — Dr. Howard's rules for giving artificial 
respiration are as follows: 

Rule 1. — To expel water from the stomach and lungs, strip 
the patient to the waist, and, if the jaws are clinched, separate 
them and keep them apart by placing between the teeth a 



ASPHYXIATION 



157 



cork or a small piece of wood. Place the patient face down- 
ward, the pit of the stomach being raised above the level of 
the mouth by a roll of clothing placed beneath it. Throw 
your weight forcibly two or three times upon the patient's 
back over the roll of clothing so as to press all fluids in the 
stomach out of the mouth. 

Rule 2. — To perform artificial respirations, quickly turn 
the patient upon his back, placing the roll of clothing beneath 
it so as to make the breast bone the highest point of the body. 
Kneel beside or astride of the patient's hips. Grasp the front 




Fir,. 98. — Howard's method of artificial respiration (Da Costa). 



part of the chest on either side of the pit of the stomach, rest- 
ing the fingers along the spaces between the short ribs (Fig. 
ItU). Brace your elbows against your sides, and steadily 
grasping and pressing forward and upward, throw your whole 
weight upon the chest, gradually increasing the pressure while 
you count one, two, three. Then, suddenly let go with a 
final push, which brings you back to your first position. 

Rest erect upon your knees while you count one, two, three, 
make pressure as before, repeating the entire motions at first 
about four or five times a minute, gradually increasing them to 



158 



TREATMENT OF EMERGENCIES 



about ten or twelve times. Use the same regularity as in 
blowing bellows and as is seen in natural breathing, which 
you are imitating. If another person is present let him, with 
one hand, by means of a dry piece of gauze, hold the tip of 




Fig. 99. — Tongue forceps used on the Philadelphia Police and Fire 
Emergency Kits. 

the tongue out of one corner of the mouth, and with the 
other hand grasp both wrists and pin them to the ground 
above the patient's head. 




Fig. 100. — The lungmotor. 

Laborde's Method. — It may be readily realized that if there 
has been an}^ injury to the chest such as fractured ribs neither 
Howard's method nor Shafer's method can be used, nor could 
Sylvester's method be used if there has been any injury to 
either arms, shoulders or chest. 



AS1MIYXIATIOX 



159 



In such a case Laborde's method must be used. 

This method depends upon the assumption that rhythmic 
and forcible traction upon the tongue causes contractions of 
the diaphragm, thereby establishing respirations. The tongue 
is grasped with tongue forceps or with the forefinger and the 
thumb, a piece of gauze having been wrapped around the 
tongue to keep if from slipping. The tongue is then pulled 
out of the mouth with considerable traction. It is held out 
while the operator counts one, two. three slowly and the 
tongue is allowed to fall back into the mouth. The operator 




Fig. 101. — The infant lungmotor. 



counts one, two, three and the tongue is again pulled out cf 
the mouth. 

Various Mechanical Devices for Administering Artificial 
Respiration. — During the past few years several mechanical 
devices for giving artificial respiration have been placed upon 
the market. Among these devices are the Metzler appara- 
tus, the lungmotor, the pulmotor, the auto-genor. and the 
lifemotor. 

The lungmotor is the apparatus used in the Police and Fire 
Department of Philadelphia. 



TREATMENT OF EMERGENCIES 




Fig. 102. — Application of mask of pulmotor, the tongue being held 
forward by forceps, and oxygen prevented from entering esophagus by 
pressure with right hand (Da Costa). 




Fig. 103. — Administration of oxygen after respirations have been 
established (Da Costa). 



ASPHYXIATION 161 

There are some who believe that all such devices are useless. 
Some believe that they are dangerous. It is not my wish 
to enter into the relative merits of the different forms of appa- 
ratus. The lungmotor has been successful in our hands in a 
number of cases. A picture of the lungmotor is shown in 
Fig. 100, infant lungmotor, in Fig. 101. A picture of the 
pulmotor is shown in Fig. 102. 

I, personally, believe that every ambulance, every patrol 
wagon and every fire truck should be equipped with one of 
these devices. Such an apparatus should also be part of the 
emergency equipment of all hospitals, all gas and electric 
companies, all mines, and all bathing pools and beaches. 



ii 



CHAPTER VIII 
DROWNING 

Drowning is caused by the victim being unable to get air 
into the lungs because .the nose and mouth are under water. 

Many are drowned because they become hysterical when 
they fall by accident or are thrown into the water. They 
attempt to scream. With each scream they use all~of the air 
contained in the lungs; then, when a breath is taken, water 
is apt to be inhaled with the air. This tends to increase their 
fright and hysteria. 

If one who does not know how to swim falls overboard if 
he or she will keep the mouth shut, breathe through the nose 
and try to tread water or paddle "dog fashion" the head can 
be kept above water for a far greater length of time than if 
one becomes immediately hysterical and uses the strength 
quickly and for no benefit. 

Every child should be taught to swim and learn to have 
confidence in the water. Every boy and girl should be taught 
to row and to sail a boat, to become accustomed to the wind, 
tide and water, and to realize the dangers of each. 

A person who is drowning becomes frightened, screams, 
attempts to wave the arms and to catch hold of anyone or 
anything near at hand. He may sink at once, never to rise 
to the surface again, or he may sink, and then rise to the surface 
a number of times. There is no physiological reason why a 
person when drowning should rise to the surface three times, 
as is the common belief. 

Treatment. — A person who has been submerged under the 
water for more than two minutes is usually dead. Yet be- 
cause of this it should not be deemed useless to try to resusci- 
tate one who has been submerged for a greater length of time. 
In fact, cases which have been submerged for five minutes or 
more have been resuscitated. 

162 



DROWNING 163 

The patient should be laid on his stomach with the head 
lower than the body, and pressure made against the chest. 
The water gravitates out of the windpipe, stomach, and lungs. 
Clear the nose and mouth of froth and mucus. Loosen the 
clothing. Then place the patient on the ground and apply 
artificial respiration by Shafer's method (see page 155). 

Keep the patient warm with blankets or hot water bottles. 
When able to swallow, give hot coffee, whiskey or brandy. 

Artificial respiration should be administered for at least 
an hour before hope of reviving the victim is abandoned. 




Fig. 104. — Method of breaking grip (front strangle-hold). 

If no apparatus for giving artificial respiration is at hand, 
apply Shafer's method. Those administering the artificial 
respiration should work in relays of about ten minutes each. 

Rescuing a Drowning Person. — It is not uncommon for 
one who becomes fatigued while in the water to clutch his 
rescuer, and often the rescuer has a difficult problem to free 
himself from the victim's grasp. Methods of breaking such 
grasps are shown in Figs. 104 and 106. 

If the victim grasps the rescuer around the front of the neck 
(front strangle-hold), the grip may be broken as in Fig. 104. 
It will be seen that the rescuer places his right hand against the 



164 



TREATMENT OF EMERGENCIES 




Fig. 105.— The strangle-hold. 




~Zk 



Ji 



Fig. 106. — Breaking strangle-hold. 



DROWNING 



165 



victim's chin and pushes backward, attempting to break the 
grip. 




Fig. 10S. — The tired carry. No. 1. 



If the victim grasps the rescuer around the neck as in 
Fig. 105, (back strangle-hold), the method of breaking the 
grip is shown in Fig. 106. The rescuer grasps the victim's 



166 



TREATMENT OF EMERGENCIES 



wrists and attempts to break the lock. The rescuer then 
dives under the victim's encircled arms and swims under 
water free from the victim's clutches. 

Methods of carrying a swimmer who has become fatigued 
are shown in Figs. 107, 108, 109, 110, and 111. 

In Fig. 107 the rescuer has grasped the victim by the hair 
and is swimming with the victim held in this manner. 




Fig. 109.— The tired carry. No. 2. 



In Fig. 108 the rescuer's left arm encircles the victim's chest, 
his left hand being in the victim's right arm pit. The victim 
lies with his back against the rescuer's left hip. This affords 
free movement of the rescuer's legs and right arm. 

In Fig. 109 the rescuer is swimming on his back and hold- 
ing the victim's head above water with his hands on either 
side of the victim's head. 

Fig. 110 illustrates the rescuer swimming on his back and 



DROWNING 



167 




Fig. 110. — The tired 



No. 




Fig. 111. — The tired carry. No. 4. 



168 TREATMENT OF EMERGENCIES 

holding the victim's head above water by means of support 
held in the victim's arm pits. 

Fig. Ill shows the "tired swimmer's carry," No. 4. The 
swimmer, becoming tired, assumes a floating posture and places 
his hands on the rescuer's shoulders, the arms being kept stiff. 
The rescuer then swims the ordinary breast stroke, thus 
pushing the victim to a place of safety. 



CHAPTER IX 
CONVULSIONS 

A convulsion or fit is a condition in which there are more 
or less uncontrollable and purposeless muscular contractions. 
When the contractions are somewhat localized they are called 
spasms. Contraction may be confined to the muscles of the 
face, arms or legs. The muscles of the whole body may be 
convulsed. Convulsions may be due to a number of different 
causes. 

Convulsions Due to Epilepsy. — Convulsions due to epilepsy 
are more common in males than in females. They usually 
occur before thirty years of age. The convulsions are general. 
They affect the muscles of the arms, legs and face. The 
patient falls unconscious and can not be aroused. A cry is 
often uttered before the patient falls. The tongue is often 
bitten. The patient froths at the mouth. This froth is often 
bloody from the bleeding tongue. After the convulsion is 
over, the patient usually falls into a deep sleep. When he 
awakens, there is no memory of the attack. 

Occasionally an individual who is subject to epileptic 
convulsions can tell a few seconds before such a convulsion 
that it is coming on. The warning may feel like a breath of 
cold air mounting from the surface of the body. This is 
called an aura. More often, however, the convulsion occurs 
without any notice and the patient falls wherever he or she 
may be. Injury may be received by such a fall. Excite- 
ment may bring on a convulsion. 

Convulsions Due to Head Injury. — Convulsions may follow 
a severe injury to the head. The convulsion may follow 
immediately upon a head injury or may ensue in a few days, 
a few weeks or even many months after the injury. Convul- 
sions following a head injury may be due to concussion of the 
brain or to laceration of the brain, to hemorrhage in the 

169 



170 TREATMENT OF EMERGENCIES 

brain between the brain coverings and the brain or between 
the brain coverings and the skull. 

Convulsions Due to Disease. — Convulsions may be due to 
alcoholism, to disease of the kidneys, or to syphilis of the 
brain. 

Convulsions in Childhood. — Convulsions in children are not 
uncommon. Such convulsions may be due to teething, irri- 
tation of the stomach, worms, constipation, a long or adherent 
foreskin or some other irritating cause. 

Convulsions from Lock-jaw. — Convulsions occur in the 
course of tetanus or lock-jaw. The muscles of the jaw are 
usually the first to be involved. There is no unconsciousness, 
the muscles of the back and the abdomen are particularly 
rigid. The rigidity never relaxes. It is temporarily increased 
by a convulsion in which the person may be bent back so as 
to rest on his heels and the back of his head. 

Convulsions from Strychnine Poisoning. — An individual 
who has taken an overdose of strychnine will have severe 
convulsions. The muscles of the neck and back are first 
involved. There is no unconsciousness. A light noise or a 
sudden movement may cause a violent general convulsion. 
Unlike lock-jaw, the muscles relax completely between the 
convulsions. 

Hysterical Convulsions. — Convulsions may be due to a 
form of nervousness known as hysteria. Such convulsions 
usually occur in women who are overworked, underfed and 
anemic. Such convulsions are common among girls who work 
in mills and factories. The convulsion may be ushered in by 
the sensation of a "ball rising in the throat." 

The tongue is not usually bitten. The individual may fall 
to the floor but is more apt to find a sofa, a couch or a chair 
to fall upon. The eyes are partially closed. Consciousness 
is not wholly lost. The muscular movements are irregular, 
violent, tumultuous. There may be laughing, crying or 
screaming. The face expresses striking and varied emotions. 
The attack is apt to terminate in a flood of tears. 

Recapitulation. — Most cases of convulsions which are seen 
on the street are due to epilepsy. A few such cases are due 
to hysteria or nervousness. 



CONVULSIONS 171 

Convulsions due to epilepsy occur more commonly in men 
than women, there is frothing at the mouth, the tongue is 
usually bitten and the froth may, therefore, be bloody. The 
individual is totally unconscious. The eyes are usualty closed. 
The face and head may show scars of old injuries inflicted by 
falls during previous attacks. The skin may show a copious 
eruption of pimples due to the administration of bromide of 
potash, a drug usually given in epilepsy. 

Convulsions due to hysteria occur in women more com- 
monly than in men. There is no frothing at the mouth. The 
tongue is not bitten. The individual is apparently conscious. 
The eyes are partially closed. 

Treatment. — The emergency treatment of any case of con- 
vulsion is to loosen the clothing, place a folded coat or blanket 
under the head, restrain the individual from injuring himself 
and to place a wedge between the teeth to prevent biting of 
the tongue. A pencil wrapped with the end of a handkerchief 
is a ready wedge. Such eases should always be removed to a 
hospital or a physician should be summoned. 

When the convulsion is due to hysteria or nervousness the 
attack may be stopped by throwing cold water on the lace 
or on the chest or even suggesting in a loud voice that such a 
procedure is to be done. 

The loud suggestion to "get a bucket of water and throw 
over her" will bring many women out of hysterical attacks. 
After recovering from a convulsion, an epileptic will often 
sleep for an hour or more during which sleep he should be 
kept warm and quiet. One recovering from an hysterical 
attack will seldom pass off into a sleep, but will be excitable, 
emotional and restless and often burst into tears. 

If a stimulant is necessary, give aromatic spirits of ammonia, 
never give whiskey or brandy. 

An individual subject to convulsions should carry a card 
of identification giving his name and address, also the name 
of the person to be notified should he be stricken with such an 
attack. 



CHAPTER X 
UNCONSCIOUSNESS 

Coma is a state of profound insensibility. It is due to 
impairment of circulation in the brain, brought about by 
injury or by organic brain disease, or by the circulation of 
poisons. When profound unconsciousness is due ~ to drugs 
or poisons, it is called narcosis. An individual in a deep coma 
can not be aroused. An individual in lighter unconsciousness 
known as a stupor, as occasionally seen in alcoholism, can 
be partially aroused. This slighter degree of unconsciousness 
is known as stupor or lethargy. 

Syncope or fainting is a temporary or brief unconsciousness, 
due to lack of blood (anemia) in the brain. It is readily 
recognized by pallor of the skin and lips, by the cold, clammy 
skin, by the shallow respiration and by the feeble pulse. 
Technically it is not a coma. Asphyxia induces unconscious- 
ness by causing the blood to become impure from excess of 
carbon dioxide. 

An individual may be found upon the street in a state of 
unconsciousness. A prisoner may be placed in a cell in 
apparently good condition. In a short time he is found in a 
state of coma. It is important that the cause of the coma in 
either of such cases be determined. It must be remembered 
that if a drunken prisoner is put in a cell he may fall from 
the bench or bed and receive a head injury, rendering him 
unconscious. It must also be remembered that if prisoners 
are put in the same cell a fight may ensue and one may be 
rendered unconscious. 

Coma may be due to head injury, alcoholism, epilepsy, 
hysteria, syncope, apoplexy (commonly known as a "stroke"), 
sunstroke, opium poisoning, or asphyxia. Coma may also be 
due to conditions known as uremia (a poison of the system 
from inflammation of the kidneys) or to diabetes. 

172 



UNCONSCIOUSNESS 173 

To recognize definitely the cause of coma requires the 
careful examination of an experienced physician and anyone 
found in a condition of coma needs the immediate treatment 
of a physician. 

If a prisoner is found unconscious in a cell or if an individual 
is found unconscious on the street, it should not be taken for 
granted that the condition is due solely to alcohol. A physi- 
cian should be summoned at once, or the case be removed to 
a hospital in an ambulance or patrol wagon. If the odor of 
alcohol is on the individual's breath, it should not be at once 
assumed that the case is only a case of alcoholism or "a 
drunk/ 7 as alcoholics are particularly liable to apoplexy 
and uremia. 

Alcoholics not infrequently fail and receive head injuries 
and occasionally an alcoholic attempts suicide by taking 
laudanum or some other form of opium. A man who has hurt 
his head or who feels sick from some other cause may have 
taken or been given alcohol with the idea that it would help 
him. Such a man would smell of alcohol and yet alcohol may 
have nothing to do with his condition. 

Any person unconscious, whether he smells of liquor or not, 
should be considered as in a serious condition until it has been 
proved that he is merely drunk. 

Method of Examination of an Unconscious Person. — If a 
person become suddenly unconscious without obvious cause, 
the first thing to do is to pry open his mouth, introduce a finger 
and make sure that the pharynx is free from obstruction. 
Otherwise a patient may choke to death while a systematic 
and detailed examination is being made. The general sur- 
roundings of the patient should be noted. Any inmates of 
the house, any bystanders or witnesses should be questioned 
as to their knowledge of the case. If the victim is found in a 
house, note any odor such as coal gas or illuminating gas. See 
if any bottles or boxes, which might contain or might have con- 
tained poison, are about the person's pockets. A quick survey 
of the surroundings can be made while working on the victim. 

Note whether the victim's skin is pale or of a healthy color, 
and whether the skin is moist, dry, hot or cold. See whether 
there are wounds or bruises about the head or body. 



174 TREATMENT OF EMERGENCIES 

Examine the eyes and note whether the pupils are equal, 
dilated or contracted and if they react to light. 

By gently touching the white of the eyeball one may 
determine whether the victim is partly unconscious or deeply 
unconscious. If the victim is only partially unconscious, by 
touching the white of the eyeball a reflex action closes or 
partially closes the eyelid. If unconsciousness be deep, there 
will be no such reaction. 

The mouth should be examined for any foreign body, such 
as false teeth, chewing gum, tobacco, etc. Any such foreign 
body, must be removed to prevent its being drawn into the air 
passages and thus causing suffocation. The odor of the breath 
should be noted. 

The breathing should be noted as to its regularity, its rate 
per minute, and whether or not it is noisy, and accompanied 
by flapping of the cheeks. In compression of the brain, the 
breathing is snoring. Technically this is known as stertor. 

The odor of the breath in uremia and in diabetic coma is 
characteristic. The odor of alcohol is suggestive. In uremia 
the breath smells of urine. In diabetic coma it smells of 
violets. 

The rate and character of the pulse of the person should be 
noticed. Is it slow or fast, is it weak or of high tension? 

The arms and legs should be examined for a fracture or 
paralysis. 

If a limb is paralyzed it will drop limp, when raised and 
allowed to fall, whereas a limb which is not paralyzed will 
drop slowly and with appreciable resistance. 

Unconsciousness from Head Injuries. — Coma following a 
head injury may be due either to concussion of the brain or 
to compression of the brain. 

Concussion of the brain is a shaking up or jarring of the 
brain causing a general depression of function of the higher 
centers. If the concussion is slight, the victim will " see stars," 
become giddy and confused and may subsequently develop 
headache, nausea, vomiting and elevated temperature. 

If the concussion is more severe, the patient may be uncon- 
scious. If the unconsciousness is not profound, he may be 



UNCONSCIOUSNESS 175 

aroused by shouting in his ear, by pinching, or by holding a 
bright light before the eyes. 

The unconsciousness may be profound but even then, if 
the case is one of pure concussion, it is temporary. He may 
answer in monosyllables. The pupils may be contracted, 
may be dilated, may be equal or unequal but always contract 
under the influence of light. 

The patient's color is pale, the skin is cool and moist, and 
the body temperature is subnormal. There may or may not 
be a contused wound or a laceration of the scalp. In some 
cases of severe head injury, there are actually no marks 
of any injury. When concussion is due to severe force, it is 
apt to be complicated by multiple hemorrhages, laceration, 
or bruising of the brain. The prolongation of the symptoms 
beyond a very few hours leads us to infer such a complication. 

The pulse is slow. If the pulse becomes rapid the prognosis 
is poor. The respirations are shallow, quiet and may be 
regular or irregular. 

Compression of the brain is due to pressure of bone following 
a fracture of the skull, to foreign bodies (as a bullet) or to 
a hemorrhage, and subsequent blood clot. 

The victim passes into unconsciousness which deepens into 
a profound coma. He can not be aroused. 

The pupils are usually unequal and may not respond to 
light. 

The pupil is usually contracted on the side of the com- 
pression. 

The breathing is rapid and there is noisy snoring, the cheeks 
vibrating with each expiration. 

The pulse is slow and hard at first. A rapid pulse gives 
a poor outlook. There may be paralysis of one side of the 
face, of a limb or of one side of the body. 

Treatment. — In all cases of head injury keep the patient 
on the back with the head on a pillow, and if shock be present 
apply hot water bottles to the body; give an enema of hot 
salt water. If respiration begins to fail, put a bag of warm 
water to the head or pour a stream of warm water upon the 
head from time to time. 

Do not give alcoholic stimulants. 



176 TREATMENT OF EMERGENCIES 

Unconsciousness from Alcoholism. — Unconsciousness due 
to alcoholism may be slight or deep. The usual case is not 
one of a deep coma. The patient is able to be aroused by 
shaking or by shouting into the ear. He usually mutters 
incoherently. There is an odor of alcohol on the breath. 
Remember the danger of being led astray by pronouncing 
all such cases purely "drunkenness" when a more serious 
condition, such as apoplexy or head injury, may be present. 

The face is usually flushed. The pupils are equal and are 
often dilated. The breathing is slow and deep. The skin is 
moist and cool. The temperature is normal or subnormal. 
The pulse is usually full and bounding from overstimulation. 
When aroused, the patient will usually mutter incoherently 
and then again pass off into sleep. 

Treatment. — Never consider that coma is due to alcoholism 
until all other causes of coma have been positively eliminated. 

Don't believe that, just because the coma is due to alco- 
holism, the patient requires no care. He should not be aban- 
doned as "simply a drunk." 

If you are sure the case is one of alcoholism, the stomach 
should be washed out by means of a stomach pump. If the 
patient is able to swallow, an emetic consisting of a teaspoonful 
of mustard and a glass of warm water may be given instead of 
using the stomach pump. Never give any emetic by mouth 
unless the victim is sufficiently conscious to swallow easily 
and safely. To try to give an unconscious man drink may 
suffocate him, the fluid running into the air passages. 

Keep the patient warm with blankets and hot water bottles. 

After the primary stimulating effect of the alcohol, there is a 
reaction and the circulation becomes decidedly depressed. 
The pulse becomes weak and rapid. In this condition give 
the person six ounces of black coffee by rectum. When he 
becomes conscious there is nausea and perhaps vomiting. 
This condition calls for aromatic spirits of ammonia or strong 
black coffee by the mouth. 

If the patient is unable to swallow the coffee, it should be 
given as an enema. 

Epilepsy. — Epileptic coma is preceded by a convulsion. If 
the patient is seen in the convulsive state, it is not hard to 



UNCONSCIOUSNESS 177 

recognize the ensuing coma, as due to epilepsy. See page 169 
for epileptic convulsions. 

Often, however, the patient is found in a state of coma and 
no one has witnessed the convulsion. How then could one 
recognize the coma as due to epilepsy? 

Coma due to epilepsy is profound and the patient can not 
be aroused. In the beginning of an attack of epilepsy the 
face is pale but as the convulsions continue it darkens and 
during the unconsciousness after the convulsion the face is 
livid. The skin is moist and cool. The eyelids are often 
open and the eyes roll. The pupils are equal. The breathing 
is regular, deep and usually noisy. The tongue is often 
bitten during the convulsion, so that there may be blood 
or bloody saliva around the mouth. The victim may show 
the scars of former injuries or a skin eruption, due to bromide 
of potash (see page 171). 

Treatment. — For the treatment of the epileptic convulsion 
see page 171. But little treatment is necessary for epileptic 
coma. Loosen the clothing. Place the patient upon a 
blanket and cover him with a coat or blanket. Allow him to 
continue sleeping without constant attempts being made to 
awaken him. After consciousness has been restored, a glass of 
water containing aromatic spirits of ammonia ma} r be given. 
Urge that a few hours rest be taken. Always advise victims 
of epilepsy to place themselves under the constant care of a 
physician, as much can be accomplished to minimize the fre- 
quency and severity of the attacks. 

Those who are subject to epilepsy should never seek em- 
ployment which will necessitate their working around machin- 
ery or working at a height. Such positions as a steel construc- 
tion worker, railroad man, steeple jack, bricklayer, or member 
of a city police or fire department should be denied them. 
They should not be given any occupation in which the lives 
of others are entrusted to their care. 

If a policeman or a fireman develops epilepsy after his 
appointment, he should be tried for disability and receive an 
honorable discharge. 

Hysteria. — Hysteria is not synonymous with deception. 
It is a nervous affliction characterized by the occurrence of 

12 



178 TREATMENT OF EMERGENCIES 

convulsive seizures, by a loss of control over the emotions, and 
functional impairments in various organs which cause confus- 
ing symptoms. 

Hysteria occurs more commonly in women and children. 
It occurs frequently among girls and women who work out in 
mills, laundries, etc., where the hours are long, the work hard, 
and the employees perhaps underfed. A so-called attack of 
hysteria is the lack of emotional control and is manifested 
by uncontrollable laughing, crying, and screaming. 

The victim of a genuine hysterical convulsion may fall on 
the street or to the floor but usually upon a couch or chair. The 
attack is ushered in by a cry as of being choked. She can 
often be aroused by pinching or by throwing water on her face 
or chest, by speaking sternly or by threatening to burn her with 
a hot iron. The pupils are unchanged. Often the individual 
closes the eyes tightly when an attempt is made to look at the 
pupils. The tongue is practically never bitten. The convul- 
sions often seem as instigated by design, for instance, she may 
grasp objects with the hands and bite persons or things. 
Sometimes she is bent backward, and rests upon the head and 
heels. She often talks confusedly during the attack. The 
face is red, not pale as in epilepsy, and after the convulsions 
cease she does not sleep. 

One who suffers from hysteria usually seeks sympathy. 
Never sympathize with one who is in a hysterical attack, but 
be stern and positive. Often the mere suggestion of some 
drastic measure as to " throw a bucket of water over her," 
or "burn her with a red-hot poker," will arouse the victim from 
her attack. Actually pouring a small amount of cold water 
over the face or chest will often serve to arouse the patient. 

Syncope. — Syncope or fainting is due to a lack of blood in 
the brain, because of a sudden weakening of the heart's action. 
Some people have a habit of fainting. They may faint at the 
sight of blood or at the sight of an impending accident. 

The patient may faint suddenly without warning or on the 
other hand may at first feel dizzy and weak, become ghastly 
pale and have beads of perspiration appear on the forehead. 
The victim may see black specks, and may hear roaring or 
ringing sounds in the ears. The hands and feet are cold to 



UNCONSCIOUSNESS 179 

the touch, and the pulse at the \\ri>t is very feeble, perhaps 
imperceptible. 

Treatment. — If a person who feels faint will at once sit clown 
and lean far over, putting the head between the knees, the 
position will often serve to revive him. If this procedure 
does not at once suffice or if the patient has actually fainted, 
he should be laid upon his back with the head lower than the 
body. The clothing is loosened about the neck, chest and 
waist and he should then be provided with plenty of air. 
If a man faints in the street, curious spectator^ crowd around 
and cut off the free access of air. Try to keep the crowd away. 
Wipe the face with a handkerchief, wrung out in cold water. 
Allow him to smell ammonia or smelling salts, but first Test 
the ammonia or smelling salts yourself to learn at what dis- 
tance it is comfortable to inhale the vapor. 

Strong smelling salts or ammonia placed too dose to the 
patient's nose may cause dangerous choking from Bpasm of 
the larynx. 

As soon as the patient is able to swallow, give well-diluted 
aromatic spirits of ammonia, brandy or whiskey. 

Those who are subject to fainting attacks and those who 
are weakened by recent illness, and who are, therefore, likely 
to faint, should keep away from crowded and from overheated 
places, such as theaters, department stores, etc.. and should 
not go upon the street alone. 

Apoplexy. — Apoplexy is due to the rupture of a blood vessel 
in the brain. The blood vessel which ruptures is diseased 
but sudden excitement or sudden muscular strain may be the 
immediate cause of the actual rupture. 

The blood escapes from the vessel into the surrounding 
brain tissue, causing unconsciousness and paralysis. This 
is known as an apopletic fit or a stroke of paralysis. 

One who is about to have an apopletic attack may have a 
few minutes warning during which time there is throbbing 
headache, dizziness, ringing in the ears and specks before the 
eyes. 

Usually, however, the attack occurs abruptly and the 
patient becomes suddenly unconscious. 

Apoplexy occurs in those of middle life or in the elderly. 



180 TREATMENT OF EMERGENCIES 

never in young unless the blood vessels of the brain are de- 
generated by some infectious disease. The breathing is 
snoring and with each expiration the cheeks vibrate. The 
eyes usually deviate and the pupils are apt to be unequal. 

An arm or leg or both (on the same side of the body) may 
be unduly limp, showing paralysis. Raise in turn each arm 
and leg. If paralyzed, it will drop absolutely helpless. The 
victim can not be aroused. 

The paralysis is on the side of the body opposed to the 
hemorrhage. 

Treatment. — The patient should be put to bed. ^The head 
should be somewhat elevated and an ice cap placed thereon. 
Hot water bottles may be placed around the body. The feet 
may be placed in a hot mustard foot bath. No stimulants 
should be given. 

Heat Stroke or Sunstroke or Thermic Fever. — Heat stroke 
is due to the effects of the direct rays of the sun. It is known 
as " sunstroke." It usually occurs on days of excessive heat 
combined with high humidity. 

The patient at first feels tired, weakened and dizzy and may 
have a throbbing headache, or a sense of oppression in the 
head. This is followed by unconsciousness. 

The body feels excessively hot to the touch. The temper- 
ature rises to 104° or even higher. The face is deeply flushed. 
The skin is hot and dry. There is no perspiration. The 
pulse is irregular and weak, the breathing labored. The 
pupils are usually unchanged. 

Treatment. — On hot days proper precautions should be 
taken to prevent sunstroke. The" clothing in summer should 
not be too heavy and should be of such a character as to permit 
free ventilation. Hats should be worn to protect the head 
from the sun. Excessive eating, and drinking of alcoholic 
beverages, especially just before physical exertion, is highly 
dangerous. 

If an individual, while working in the sun, feels weak or 
dizzy or has a dull, throbbing headache or a sense of oppres- 
sion, he should at once stop work, take a cool bath, or if that 
is not obtainable bathe the head and the hands in cold water. 



UNCONSCIOUSNESS 181 

The patient should lie down in a shady or an airy place if there 
is one adjacent, and rest quietly for an hour or two. 

If actual coma has occurred, remove the patient at once to 
a cool place. Remove the clothing; and sponge the whole 
body with ice water. Place ice cloths or an ice bag on the 
head. If possible place the patient at once in a tub of ice- 
cold water. While in the tub the patient must be rubbed 
vigorously. Alcohol is positively contradicated. As soon 
as consciousness has returned give cool drinks freely. 

Heat Exhaustion. — Those who work in poorly ventilated, 
hot rooms are particularly apt to become the victims of heat 
exhaustion. 

The early symptoms of headache, weakness and malaise 
are not unlike those of heat stroke. 

In heat exhaustion, however, the skin is moist and pale. 
The temperature is below normal and the surface of the 
body is, therefore, cool. The victim is dazed and perhaps is 
unconscious. 

Treatment. — Remove the patient to a quiet place. If the 
temperature is below normal cover the body with blankets. 
Loosen the clothing. Give aromatic spirits of ammonia, hot 
tea, or coffee, or a small amount of whiskey or brandy. 

Opium Poisoning. — Morphine, paregoric, and laudanum, 
are all derived from opium. Many cough medicines, chil- 
dren's soothing syrups, medicines for diarrhea and for insomnia, 
contain some form of opium. 

Children stand opium very poorly; therefore, no such 
medicine should be given to a child without a doctor's advice. 

Any bottle containing such medicine should be conspicuously 
labeled or so designated that its contents may be readily 
known by merely handling the bottle. 

The symptoms of an overdose of opium or one of its deriva- 
tives are drowsiness and muscular weakness, followed by coma. 
The sleep is profound; even after a moderate dose it is diffi- 
cult to arouse the victim. After a large dose it becomes 
impossible. The respirations are very slow, at times only four 
or five per minute. The skin is moist and cool. The pupils 
are characteristic, being so contracted that they are called 
"pin point" or "pin hole" pupils. Those who take opium 



182 TREATMENT OF EMERGENCIES 

habitually are liars, and make every effort to conceal the use 
of the drug. Occasionally an opium habitue has normal or 
even dilated pupils, although he may be strongly under the 
influence of the drug. In these cases the habitue uses atropine 
in the eyes to counteract the action of opium in contracting 
the pupils. He uses the atropine in order that the opium habit 
may not be suspected. 

Treatment. — The stomach must be washed out at frequent 
intervals, by means of a stomach pump. The opium is 
secreted and then reabsorbed by the stomach. This necessi- 
tates the washing out of the stomach at such intervals. 

Permanganate of potash is the antidote. A solution of 
permanganate of potash in the strength of fifteen grains to a 
quart of warm water may be used in washing out the stomach, 
or three to five grains may be administered after the stomach 
has been washed. 

Keep the patient awake by walking him about, by cold 
douches, or by an electric brush. Give coffee by mouth if the 
patient is able to swallow; if not, give the coffee by enema. 

If breathing becomes so slow that there is danger of sus- 
pension, artificial respiration is imperatively required. 

The best antagonist to opium is atropine hypodermatically. 
This is given by the physician. 

Coma from asphyxiation from smoke or the fumes of 
illuminating gas has been discussed on page 148. 

Uremia. — Coma from the condition known as uremia is 
difficult for the layman to recognize. It is due to the reten- 
tion in the blood of certain poisonous material which should 
be eliminated by the kidneys. 

The condition may develop suddenly or slowly. When it 
develops slowly it is preceded by headache, and vertigo, 
perhaps by delirium and convulsion. 

When the coma develops, the temperature of the body is 
subnormal, the skin is dry, and there is a urinous odor to the 
breath. The pupils are small and equal. There is no 
paralysis and no snoring respiration. 

Treatment. — Until the arrival of a physician an attempt 
should be made to make the patient sweat freely. This may 



UNCONSCIOUSNESS 183 

be best accomplished by wrapping him in blankets which have 
been wrung out in hot water. 

If the patient is able to swallow, give plenty of hot water 
to drink and give a purgative, for instance, a dose of castor oil. 

Coma from Diabetes. — Acetonemia. — Coma in a diabetic 
is due to the accumulation in the blood of certain ill-oxidized 
acid products of breaking down of fat. These products can be 
identified in the urine by chemical tests. The urine containing 
them smells like violets and contains sugar. Sugar can appear 
in the urine in conditions other than diabetes, for instance, 
after the administration of chloroform, or after starvation, but 
it is far and away most common in diabetes. Diabetes is of 
gradual onset with the symptoms of headaches, loss of weight 
and the daily passage of large amount of urine. Not every 
diabetic gets coma but every diabetic is in danger of it. The 
coma appears rapidly, being preceded by vomiting, weakness, 
restlessness, and drowsiness, which passes into stupor and then 
into coma. The respirations are also slow and deep. The 
pulse is weak and frequent. The temperature becomes sub- 
normal. The pupils will react to a bright light. 

There is nothing characteristic about the coma except that 
it is accompanied by the sweetish odor of the breath and urine. 
It has been described as the odor of violets. 

Treatment. — Unfortunately, practically all of those suffer- 
ing from diabetic coma die without regaining consciousness. 
The layman can be of no service. 



CHAPTER XI 
EFFECTS PRODUCED BY LIGHTNING 

Each year approximately 224 persons in the United States 
are killed by lightning. It is believed that death from 
lightning is due to asphyxia and to paralysis of the heart. 

Some of the pranks played by lightning are most extra- 
ordinary. There is a case on record of lightning having struck 
an iron bed in which two children were sleeping, one child 
being killed, the other remaining unharmed. An individual 
may be killed by lightning and the clothing not be damaged. 
An individual's clothing may be burned and the individual 
escape unharmed. The shoes, especially those containing 
metal nails, are apt to be torn off. 

A person killed by lightning may remain in the exact posi- 
tion he was in when struck. In most fatal cases the body 
shows burns. In a few fatal cases, however, there is no sign 
of burn. 

About one-third of those struck by lightning are killed; of 
the other two-thirds who recover, many are usually left in a 
highly nervous condition for a number of months. Some 
are paralyzed. This paralysis usually clears up. Some are 
blinded; others become insane. Individuals who recover from 
a stroke by lightning are highly nervous during subsequent 
electric storms. 

Precautions Against Lightning Strokes. — There is no place 
where one is absolutely secure against a stroke by lightning. 
It is far safer to be indoors and to keep away from the draught 
of an open chimney, fireplace, window or door. 

Shelter under a single tree, under the highest tree of a clump 
of trees or under a tree at the edge of a forest is dangerous as 
such a tree is apt to be struck. It is dangerous to be near 
horses, cattle or other animals. Do not stand near a tele- 
graph pole. Do not use a telephone during an electric storm. 
It is dangerous to stand near a pool. 

184 



EFFECTS PRODUCED BY LIGHTNING 185 

Treatment. — Never give up an individual as dead until all 
measures have been used for resuscitation. Many have been 
resuscitated who have been apparently dead, some even for 
a number of hours. 

Loosen the clothing, lay the patient on his stomach and 
give artificial respiration by the Shafer method. Occasion- 
ally raise the head, open the mouth and tickle the back of 
the throat with the finger or with a feather or tickle the 
nostril with a feather. 

Apply external heat by means of blankets and hot water 
bottles. Massage the arms and legs. Don't give alcoholic 
stimulants. Give aromatic spirits of ammonia or coffee when 
consciousness has been regained. Enemas of hot salt solution 
or hot coffee may be given if the victim is unconscious. 

A careful examination must be made to detect any burns, 
wounds or fractures. 

Occasionally after an electric shock the victim will have 
peculiar tracings or markings on the skin. These markings 
correspond to the course of blood vessels and are due to the 
disorganization of the blood running through them. 

Effects of Artificial Currents. — Electric shock may be due 
to direct contact with a charged or "live" wire or may be 
due to contact with some object which has been charged by 
a short-circuit. 

Occasionally a hook and ladder truck becomes charged with 
electricity while at a fire and a whole company of firemen 
receive a shock. This is caused by the contact of the exten- 
sion ladder with an overhead wire. It is more apt to occur 
in cold weather when ice freezes over the ladders and over the 
truck. The ice-covered ladder makes a good conductor for 
the electricity. 

Individuals differ greatly as to the amount of electric cur- 
rent which they are able to withstand. Some have been 
killed by a comparativel}' weak current, others have withstood 
a very strong current. 

If an individual standing upon a wet or metal floor comes 
into contact with a charged wire, he will receive a greater 
shock than if he were standing upon a dry floor or a floor made 
of material other than metal. 



186 TREATMENT OF EMERGENCIES 

If an individual is wearing shoes with metal nails when he 
comes into contact with an electric current, he will receive 
a greater shock than if he were wearing shoes without metal 
nails. 

If the palm of an individual's hand, where the skin is thick, 
comes into contact with the current, the shock will not be as 
great as though the contact were made on the surface of the 
skin where the skin is not so thick. 

There may be a burn on that part of the surface of the skin 
which receives the contact. The burn may be slight or severe, 
depending upon the strength of the current, the amount of the 
body exposed to the contact and the character of the clothing 
overlying the part. 

The stronger the current, the greater will be the burn. 

If the area of the skin contact be small, the burn is apt to be 
great and the degree of shock moderate. If the area of the 
skin contact be great, the shock is severe and the burn slight. 

If the skin is exposed or covered with dry clothing, the 
burn will be great and the shock is apt to be moderate. If 
the skin is wet or if the skin is covered with wet clothing the 
burn is not so great but the shock is more severe. 

A man working in an underground main was recently 
electrocuted. He leaned against an exposed wire. The 
contact was made through his shirt which was wet with per- 
spiration. He was killed immediately. The current caused 
a slight burn of the first degree. The skin was barely 
reddened. 

Burns caused by electricity heal slowly and tend to slough. 
This is probably due to the fact that the nerves supplying 
the part are injured or destroyed by the electric shock. 

Prevention of Electric Shock. — By precaution, electric 
shocks can, to a large extent, be prevented. Never touch a wire 
hanging from a pole. Never step upon a wire lying in the 
street. Police and fire boxes on street corners are sometimes 
charged by a short-circuit; therefore, never touch them un- 
necessarily. A man recently touched one of these boxes with 
his umbrella. The umbrella had a steel handle. The fire 
box was on a short-circuit and consequently the man received 
a shock severe enough to knock him down. 



EFFECTS PRODUCED BY LIGHTNING 



187 



When walking through an engine room never touch any 
metal object around a dynamo or motor. Never try any 
experiments nor attempt to repair electric lights, switches nor 
any other electrical apparatus unless you are thoroughly com- 
petent to make such experiments or such repairs. 

Whenever it is necessary to cut an electrical wire with 
shears or to handle such a wire, rubber gloves should be worn. 
Such gloves should be carried on every ambulance, fire truck 
and police patrol wagon. Always treat electric wires as 
though they are dangerous until proved otherwise. 




Fig. 112. — Lifting electric wire with use of wooden pole. 



Treatment. — If an individual is in contact with a charged 
wire, try at once to have the current shut off. If it is not 
possible to have the current shut off, great care must be used 
in moving the victim from the wire. It is dangerous to try 
to pull the victim from the wire by his clothing as the clothing 
may be wet. You may accidentally touch him and receive 
the shock yourself. You may pull the wire as you try to drag 
him away from it. 



188 



TREATMENT OF EMERGENCIES 



If rubber gloves and shears are at hand, the wire may be 
cut. The wire may be pushed away with a piece of wood as 
in Fig. 112. 

The victim may be rolled away from the wire by means of 
a board or wooden pole as in Fig. 113. 

After the victim is free from contact with the current, he is 
resuscitated in a manner as set forth on page 153. 

If he has received a burn it is treated as set forth on page 138. 




Fig. 113. — Rolling man from electric wire with use of wooden pole. 

Precautions To Be Taken by Firemen Regarding All Wires. 

— All wires should be treated as being alive at all times. 
On arriving on the fire grounds the fireman is likely to 
encounter any or all of the following, as regards wires and 
voltages : 



EFFECTS PRODUCED BY LIGHTNING 189 

Trolley Current: 500 to 600 volts direct current. This 
feed wire is run bare and contact with this wire is dangerous, 
and it is to be avoided. As the traction company send their 
emergency wagon on most fire alarms, let them handle this 
wire if it is an impediment to proper fire fighting. 

Electric Light and Power Wires. — These wires are erected on 
wooden poles set at the curb line and clear the highway by 
about thirty feet. The wires are insulated, but it is well not 
to place too much faith in insulation, especially at time of 
fire when water and flames are so prevalent, and these two 
elements destroy (to a certain extent) the efficiency of the 
insulation. 

4000 to 7500 volts direct current for series arc lamps, used 
principally for street illumination, is found throughout the 
city. 

5000 volts alternating current is found on feeders from 
station to substation and sometimes is fed into large industrial 
plants. 

2400 volts alternating current is used for distribution to the 
various centers from which it is reduced to 230 volts and 115 
volts to supply the various houses, stores, small factories, etc. 
This is the average condition encountered throughout the city. 

Within the building the voltages are 115 to 230 volts direct 
current and alternating current. The fireman must bear in 
mind that in many cases electric wires are concealed in the 
partitions and ceilings, and truckmen should be cautious in 
tearing down lath and plaster, not so much because the shock 
is dangerous, but it is unpleasant, besides which, in the case 
of a slight fire at night, the careless use of the hooks will de- 
prive the firemen of a good light. 

Telephone, telegraph and door-bell wiring should not be 
treated with contempt, as under the conditions existing during 
the progress of the fire or the extinguishing of same, these 
wires are likely to become crossed with wires of higher voltage 
and give the firemen a shock. 

If it is necessary to cut the current off the building the 
main switch is usually in the cellar close to the front wall. 

It is well not to remove the open single wire that is attached 



190 TREATMENT OF EMERGENCIES 

to the water pipe, as this wire is what is known as a "ground" 
and is installed as a protection against fire and life hazard. 

In addition to the above there are manhole fires. Fires in 
manholes containing electric conductors are to be handled 
cautiously as the fire usually indicates the presence of gas 
and this gas ignited by the flash caused by defective electric 
conductors or appliances. 

Fires in manholes should never be fought with water or 
chemicals; dry sand or pyrene is the only safe and sure method 
of extinguishing these very stubborn and difficult fires. 

The voltages encountered in manholes is identical to that 
found on overhead wires with the addition of some few 13,200- 
volt feeders. 

On all box alarms the electric company dispatch a "trouble 
man" and this man is equipped to take care of such wires as 
interfere with the fighting of the fire. This man is subject to 
the orders of the fire department official in charge of the fire. 



CHAPTER XII 

FOREIGN BODIES 

Foreign Bodies in the Eye. — Foreign bodies frequently get 
into the eye and produce severe burning or scratching pain, 
watering of the eye, redness of the white of the eye, reflex 
contractions of the lids, and brow ache. The patient may 




Fig. 114. — First step for everting upper eyelid to search for a foreign 

body. 

open the eye with great difficulty and exposure to light causes 
pain and contractions of the lids. The particle is usually 
a cinder, or a small bit of sand, dirt or metal filing. 

If the cinder be hot, it will cause a burn of the cornea. 

The symptoms are well known. There is a burning, scratch- 
ing pain. The eye waters profusely, and becomes red. There 
is difficulty in opening the lids. Light hurts the eye. 

191 



192 TREATMENT OF EMERGENCIES 

Treatment. — The patient should not rub the eye, as by doing 
so he causes the foreign body to scratch the surface of the eye- 
ball and may imbed the body. At first try pulling the upper 
lid over the lower lid, then allow the upper lid to draw itself 
back into place. By this method the eye lashes of the lower 
lid may catch a foreign body from the upper lid and draw it 
out. 

If this method fails, the upper lid may be everted over a 
match stick, a pencil or a finger. At first tell the patient to 
"look down" then grasp the eye lashes of the upper lid 




Fig. 115. — Eversion of upper eyelid. 

between your thumb and forefinger, pull the eyelid slightly 
downward and turn it so that it is everted over the match 
stick as shown in Fig. 114 and Fig. 115. 

If the foreign body is then in view on the undersurface of 
the upper lid, it may be removed by means of a small amount 
of cotton wrapped on the end of a match stick, by the corner 
of a clean handkerchief wrapped around a match stick, or by 
a camePs-hair brush. 

If the foreign body is embedded on the eyeball, none but 
a physician should attempt its removal, for fear of scratching 



FOREIGN BODIES 193 

the surface of the eyeball and causing an ulcer. The same 
precaution should be used with those who get metal filings 
or stone dirt in their eyes. 

After the foreign body has been removed, the eye should 
be washed with a solution of boric acid, and the same solution 
should be used at intervals for a day or two. 

Danger of Using Cocaine. — Those who perform first aid 
work in the fire ground and are obliged to remove foreign 
bodies from the eye, should use cocaine with great care. Never 
use a solution stronger than 1 per cent, or 2 per cent. After 
using cocaine to remove a foreign body from the eye, never 
allow the fireman to return to the fire, as the cornea or eyeball 
is insensitive and a subsequent cinder or hot smoke may 
gravely irritate the eyeball without the fireman feeling it. 

Foreign Bodies in the Ear. — Children not infrequently 
place foreign bodies, such as beads, buttons, pieces of corn, 
etc., into the ear. It is, moreover, a not infrequent occur- 
rence for campers while sleeping on the ground to have an 
insect crawl into the ear. 

Treatment. — Never try to remove a foreign body from the 
ear with such a devise as a match stick, a piece of wire, a pin 
or a needle. Not only will the attempt be unsuccessful but 
it will probably push the foreign body further into the ear 
canal, and it might injure the canal or drum. 

The only instrument which should be used by a layman is a 
syringe. The ear should be syringed with soap suds or with 
boric acid solution. 

If the foreign body is a bean, a piece of corn or some such 
substance which will tend to swell if a watery solution is used, 
syringe with alcohol. The alcohol will tend to shrink rather 
than swell the object. 

If the foreign body is an insect, try holding a light near the 
ear. Occasionally the insect will come out to the light. If 
this plan is unsuccessful drop one or two drops of paregoric, 
laudanum or sweet oil into the ear. This will kill the insect. 
Then syringe the ear with soap and water or with boric acid 
solution. 

Dr. MacCuen Smith, while in the Maine woods removed an 
insect from his guide's ear by placing a few drops of sweet oil 

13 



194 TREATMENT OF EMERGENCIES 

into the ear and syringing the ear using the stem of a clay pipe 
as a syringe. A mouthful of water was squirted into the ear 
through the clay pipe stem. 

Foreign Bodies in the Nose. — Foreign bodies are sometimes 
placed in the nose by children, by hysterical people, or by 
insane persons. If one of the nostrils of a child becomes 
inflamed and has a purulent discharge, the presence of a 
foreign body should be suspected. 

Treatment. — The foreign body is usually expelled by sneez- 
ing. To excite sneezing, a small amount of pepper or snuff 
may be given or the opposite nostril may be tickled with a 
feather. 

If a child be a victim, hold the child's mouth closed and 
blow into the open nostril, or hold the nostril closed and blow 
into the child's mouth. 

Foreign Bodies Lodged in the Throat. — Coins, fish bones, 
toys (such as whistles), nut shells, false teeth, pins and needles, 
and particles of food may become lodged in the throat. 

If the object be small, as a fish bone or a pin, there will be 
no sign of suffocation unless from spasm of the throat. If, 
however, the object be a large body, for instance a whistle 
or a large piece of meat, there may be immediate signs of 
suffocation. 

Particles of food may be drawn into the larynx by a sudden 
inspiration while laughing. 

Occasionally a drunken man, while attempting to bolt a 
large mass of food, will have a large piece of unchewed meat 
lodge in the larynx. 

This may also occur to one who is stricken with an epileptic 
fit while eating. 

Symptoms. — If a fish bone, a needle or some sharp object 
lodges, there will be a sticking pain, especially when attempt- 
ing to swallow. The patient will have fits of coughing, 
gagging and vomiting. The voice becomes croupy. If the 
object be large enough to occlude the larynx, there will be 
signs of suffocation. The patient's face becomes blue, he 
gasps for breath and clutches his throat. He fights for air 
and coughs and gags and then can not get his breath, sweat 
pours from his forehead and he is terrified. He finally falls 



FOREIGN BODI1 M). r ) 

unconscious. One who has scon tins picture will never 
forget it. 

Treatment. — Force the mouth open with the handle of a 
fork, or anything suitable which is at hand. Try to remove 
the foreign body, with your index and middle finger. Even 
if you are unable to grasp it, this procedure may cause the 
patient to vomit which may dislodge the foreign body. 

If the case be that of a child, hold it up by its feet, while 
trying to remove the foreign body with your fingers. 

If the foreign body be a large piece of food, it may bo n< 
sary to grasp it with a pair of surgeon's forceps, to remove it 
(see Fig. 116). 




Surgeon's forceps 1 1 ):i ( '■ 



Only in severe cases, however, and in cases where a physician 
can not be reached, is it justifiable to attempt to use an instru- 
ment, as the forceps may grasp the mucous membrane of the 
throat and cause a nasty wound. 

A case was recently observed in which a mother had at- 
tempted to remove a foreign body from her child's throat 
with a button hook; the foreign body was removed but in 
doing so the pillars of the tonsils were badly torn, and the 
subsequent hemorrhage was so severe that the wounds had 
to be stitched. 

If, after the foreign body has been removed, the patient 
does not at once breathe, make artificial respiration (see page 
153). 

It should be emphasized that in any case of asphyxia, the 



196 TREATMENT OF EMERGENCIES 

throat must first be examined to see that there is no foreign 
body lodged therein. 

Foreign Bodies Which Have Been Swallowed. — Large 
foreign bodies are seldom swallowed, excepting by children, 
drunkards, hysterical persons and the insane. 

Anyone may accidently swallow a small object as a button, 
pin, coin, fish bone, tack, etc. The foreign body may lodge 
in or may pass successfully through the stomach and the 
intestines. 

It should be remembered that any foreign body which can 
pass through the gullet is not too large to pass through the 
stomach and the intestines. It may get into a bad position 
and lodge or, if sharp, it may stick into the wall of the stomach 
or intestines. 

Symptoms. — In some cases there are no symptoms. The 
foreign body passes through the entire alimentary tract 
without any inconvenience other than mental anxiety. 

In other cases there are violent symptoms. The severity 
of the symptoms depends upon the character of the object 
swallowed. 

There may be nausea, abdominal pain and vomiting. 

If the irritating object is not vomited, but passes from the 
stomach into the intestines, it may cause severe diarrhea which 
may become bloody, and associated with griping colicky pains 
in the abdomen. 

Treatment. — A foreign body having been swallowed not 
infrequently requires a surgical operation to remove it from 
the gullet, stomach or the intestines. 

If it has become lodged, it may cause an ulcer or an abscess 
at the point where it is lodged. 

When a small or a sharp foreign body has been swallowed, 
do not give an emetic to induce vomiting, and do not give a 
purge as the latter increases the action of the intestines and 
renders intestinal perforation by the foreign body more 
liable. 

Give the patient such food as mashed potatoes, mush, 
bread and milk, and suet dumplings, for two days. By this 
means the foreign body will become encrusted and will be 



FOREIGN BODIES 197 

less liable to injure the intestines during its passage through 
them. 

At the end of the second day a mild laxative should be 
given. The stools may be watched to see if the foreign body 
is passed. 



CHAPTER XIII 
ANTISEPTICS 

Sepsis or blood poisoning is a condition due to the entrance 
into the blood of bacterial poisons or of bacteria themselves. 
Poisons arise when certain bacteria multiply in the blood, in 
the tissue or in the wound fluid. Microorganisms or bacteria 
are minute cells which can be seen only under the high- 
powered lens of a microscope. The poison from these cells, 
when absorbed and carried through the lymph or blood, causes 
general blood poisoning. 

Wounds which heal readily without pain, swelling or des- 
tructive inflammation have not become contaminated with 
bacteria. 

Wounds which become red, swollen and inflamed are con- 
taminated. This contamination or infection may have been 
carried into the wound on the object causing the wound, or 
may have gained entrance subsequently by careless handling 
of the wound or by the application of dirty dressings. 

Asepsis aims at the exclusion of all bacteria from a wound 
by the sterilization of all objects which will come into contact 
with it, such as the operator's hands, the instruments, and 
the dressings. 

Antisepsis aims at the destruction of bacteria which have 
gained entrance into a wound, by the application to the wound 
of such agents as bichloride, carbolic acid, etc., which kill bac- 
teria. Such agents are spoken of as antiseptics, but more cor- 
rectly as germicides. 

GERMICIDAL AGENTS 

Heat is the quickest and most reliable method known for 
destroying bacteria. Of course, neither a wound nor the 
surgeon's hands can be disinfected by means of heat. 

198 



ANTISEPTICS 199 

All instruments, water and dressings can best be sterilized 
by heat. The heat employed may be dry or moist heat. 
Moist heat is more efficient than dry heat. Xo bacteria can 
wil listand a temperature of 212°F. of moist heat (the tempera- 
ture of boiling water). Water can be thoroughly sterilized 
by boiling for a short time. All instruments should be boiled 
for at least five minutes. In order to keep the instrument- 
from rusting a little bicarbonate of soda is usually added to 
the water. Surgical dressings are best sterilized by subjecting 
them to steam under pressure. 

In order to sterilize surgical dressings in an emergency 
they are wrapped in a towel and placed in a hot oven for half 
an hour, or are boiled in water for the same length of time. 

Bichloride of mercury or corrosive sublimate is frequently 
employed as an antiseptic. It is used in a watery solution. 
To disinfect the hands and skin a solution containing 1 part of 
the drug to 1000 parts of water is used. To make a solution 
of the strength of 1 in 1000 take a seven and a half grain 
tablet and dissolve it in a pint of warm water. If too strong 
a solution is used on the skin it will cause violent inflammation. 
Because of the poisonous nature of the drug, it is well when 
purchasing it to obtain the tablets which contain a little 
coloring matter. Then the solution made with it can be 
readily distinguished from other solutions. 

In a clean, incised wound, such as is made by the surgeon, 
no infection is expected and bichloride should not be used 
because of its irritating effects upon the tissues. When used 
in infected wounds, it is emplojxd in the strength of 1 to 
2000 to 1 to 4000. A hot solution is more effective than a 
cold solution. A badly infected wound should be irrigated 
with a solution of the strength of 1 to 1000. When a wound 
has been irrigated with a solution of corrosive sublimate drain- 
age is necessaiy, to favor the escape of wound fluid, much of 
which will tend to form because of the irritation of the drug on 
the tissues. Bichloride of mercury is not germicidal in fatty 
tissues as it is unable to reach the oil-covered bacteria. It 
should never be used on a serous membrane because of its 
irritating effects and because it is readily absorbed and may 
cause mercurial poisoning. Instruments should never be 



200 TREATMENT OF EMERGENCIES 

sterilized in a bichloride solution because mercury is deposited 
on the metal, and tarnishes the instrument and corrodes 
them. Knives are quickly dulled by corrosive sublimate. 

Carbolic Acid or Phenol.— Carbolic acid or phenol is ob- 
tained from the distillation of coal-tar. A solution of the 
strength of 1 part of carbolic acid to 20 parts of water may be 
used to sterilize instruments. The instrument should be left 
in the solution for at least thirty minutes. As solution of this 
strength is very irritating to the hands, it should be diluted 
with an equal quantity of boiled water just before the instru- 
ments are to be used. One and one-half tablespoon fuls of 
carbolic acid to one pint of boiled water makes a 1 to 20 solu- 
tion. Carbolic acid is very irritating to the tissues and should 
never be used in a clean wound. It may be used in an infected 
wound. 

Carbolized dressings may be responsible for sloughing or 
gangrene, especially if used on the fingers or toes (see page 
73). They should never be applied or ordered by any person 
but a physician. Like corrosive sublimate, carbolic acid will 
not kill bacteria in fatty tissue. 

Pus or blood greatly weakens the disinfecting power of 
carbolic acid. To irrigate wounds, carbolic acid is used in 
the strength of 1 to 60 to 1 to 80. All wounds which have been 
irrigated with carbolic acid should be drained to allow the 
escape of wound fluid. Pure carbolic acid is used to cauterize 
or disinfect a puncture wound or poisoned wounds. The 
skin around the wound is moistened with alcohol and the 
wound is disinfected with the pure carbolic acid applied by 
means of a small swab. The excess of acid is antidoted by 
the application of alcohol and the wound is drained. For 
carbolic acid poisoning see page 316. 

Boric Acid. — Boric acid is a mild antiseptic. The powdered 
boric acid may be used to dust into wounds or upon a sewed-up 
wound. A solution of the strength of five teaspoonfuls of 
boric acid to one pint of boiled water is used as an eye wash 
or an ear wash. A solution of the same strength may be used 
to irrigate wounds or for hot fomentations. Boric acid is 
especially useful in the treatment of wounds of infants when 
the skin and tissues are tender. 



ANTISEPTICS 201 

Peroxide of Hydrogen. — Peroxide of hydrogen is employed 
to irrigate purulent and putrid wounds. It should never be 
used in sterile wounds. It should be diluted with an equal 
amount of water before using. Its use for a long period of 
time is inadvisable as it may retard granulation and so delay 
healing. 

Creolin. — Creolin is made from soft coal by dry distillation. 
It is a germicide inferior in power to carbolic acid but acting 
similarly. It is, however, not irritating to the tissues, and is 
but slightly poisonous. It does not dissolve in water but 
forms an opaque emulsion with water up to the strength of 
12 per cent. It is used in a strength of from 2 to 5 per cent. 

Permanganate of Potassium. — Permanganate of potassium 
may be used in the strength of 1 to 5000 for the irrigation of 
wounds. It is used to disinfect foul wounds. The solution 
is formed by dissolving one teaspoonful of permanganate of 
potash in an ounce of boiled water. One teaspoonful of this 
concentrated solution to a pint of water makes a solution of 

1 to 1000. 

Acetate of Aluminum. — This drug is a mild non-irritating 
and non-poisonous antiseptic. It is used in a 1 per cent, to 

2 per cent, solution. It is one of the safest and best antiseptic 
solutions to employ for wet dressings. Its prolonged use, 
however, tends to harden the tissues. 

Thiersch's Fluid. — Thiersch's fluid is a mild antiseptic, 
non-irritating and non-poisonous antiseptic and may be used 
to irrigate wounds. It consists of one grain of salicylic acid 
and six grains of boric acid to one ounce of sterile water. 

Iodine. — Iodine may be used in a 1 per cent, or 2 per cent, 
solution to irrigate wounds. A 2 per cent, to 4 per cent, solu- 
tion is used to disinfect wounds before the application of a 
first aid dressing. A 5 per cent, to 7 per cent, solution is to 
disinfect the skin before operating. It may be used to disin- 
fect a puncture wound if carbolic acid can not be obtained 
and for such purpose should be used in full strength of the 
tincture. 

Iodoform. — Iodoform powder may be dusted into an infected 
wound, or iodoform gauze may be packed into the wound. 
Iodoform prevents the decomposition of wound discharge. 



202 TREATMENT OF EMERGENCIES 

The drug must be used cautiously as absorption of it may cause 
iodoform poisoning. The symptoms of iodoform poisoning 
are acute delirium, nausea, fever and watering of the eyes, 
yellowness of the skin and eyes, and the odor of iodoform 
upon the breath. Chemical tests will prove the presence of 
the drug in the urine. The drug should not be used over a long 
period of time in a large wound for fear of causing poisoning. 

Betanaphthol. — Betanaphthol is non-irritating and is not 
poisonous. It may be used in a solution of 1 to 2500 to irrigate 
wounds. The drug may be used as a dusting powder, especially 
upon sloughing wounds that have been contaminated by urine 
or feces. 

Chloride of Zinc.^ — Chloride of zinc is a powerful antiseptic. 
It is employed in a strength of thirty grains to the ounce of 
water to disinfect poisoned wounds, especially wounds that 
have been received while dissecting a dead body. Such a 
wound should be washed out with a solution of zinc chloride 
and then dressed with bichloride of mercury gauze. Zinc 
chloride blanches the tissues. 

Formalin. — Formalin is a 37 per cent, solution of for- 
maldehyd gas in water. A solution of full strength may be 
used to cauterize the tissues. A 1 per cent, solution may be 
used to disinfect wounds. A 2 per cent, solution is used to 
disinfect instruments. 

Lysol. — Lysol is saponified phenol. It is used in solution 
of 1 to 3 per cent. It is not as irritating as carbolic acid. 

Aristol. — Aristol is a compound of iodine and thymol. It 
is used as a dusting powder. 

Acetanilid. — Acetanilid powder may be used upon suppu- 
rating or sloughing wounds. In some cases absorption pro- 
duces serious symptoms, sweating, weak pulse and blueness of 
the face, from respiratory failure. 

Commercial Gasoline. — Gasoline is sterile and non-irritat- 
ing. It may be used to disinfect the skin or a wound. The 
vapor is so highly inflammable that great care must be used 
never to employ gasoline near gas lights, lamps or any kind 
of fire. 

Alcohol. — The best germicidal strength of alcohol is 70 
per cent. In this strength it may be used for disinfection of 



ANTISEPTICS 203 

the hands of the operator or the skin of the patient. Pure 
alcohol is used to counteract the effect of carbolic acid on the 
tissues. 

Mustard. — Mustard is an excellent household or emergency 
disinfectant and germicide. A mixture of mustard, corn meal 
and soap disinfects the operator's hands or the patient's skin. 
Mustard also readily removes the odor of decay. 

Disinfection of Excreta. — Urine and feces may be disin- 
fected by thoroughly mixing with twice their amount of a 1 
per cent, solution of chlorinated lime, or a 2 per cent, solution 
of formalin. The excreta should remain in either of the above 
solutions for at least three hours. 

Urine and feces can be disinfected with a solution of 1 to 20 
carbolic acid (one and one-half tablespoonfuls of carbolic acid 
to one pint of water). The solution of carbolic acid should 
be sufficient amount to cover the two*. 

Disinfection of Bed Clothing, etc. — When possible, bedding, 
clothing, carpets, etc., should be disinfected by steam. Towels, 
napkins, and sheets should be soaked in a 5 per cent, solution 
of carbolic acid and then boiled. A mattress which has become 
contaminated should be burned. All articles of little value 
should be burned. 

Disinfection of a Room. — The Philadelphia Bureau of 
Health has issued the following rules for performing 
disinfection: 

" Disinfection is to be performed in the following manner: 

"The room to be disinfected is sealed by pasting strips of 
paper over cracks of door and windows; all its surfaces are 
exposed as much as possible; closet doors are opened and their 
contents, together with the contents of drawers, are removed, 
scattered about, and the drawers left open; mattresses are set 
on ends; pillows, bedding, clothing, etc., are spread out so as 
to expose all sides; the room and its contents are so disposed 
of as to secure free access of the gas to all parts as fully as 
possible. 

"For every one thousand (1000) cubic feet of air space in 
the room, take three (3) pints of 40 per cent, solution of 
formaldehyde and add three pints of water, making six (6) 
pints of a 20 per cent, solution per one thousand cubic feet. 



204 TREATMENT OF EMERGENCIES 

"This is to be introduced into the rooms by spraying 
apparatus. 

"On leaving the room the outer door is to be sealed, with 
instructions that the room is not to be opened in less than 
twelve (12) hours.' ' 

Milk bottles, drains, cesspools or privy vaults, manure pits 
and garbage cans are to be disinfected with chloride of lime» 



CHAPTKH XIV 
BANDAGING 

Bandaging is the art of applying bandages. A bandage is 
employed to hold surgical dressings, medicinal applications. 
or splints in place; to make pressure in order to prevent or 
reduce swelling of a part; and to correct deformity. 

Various materials may be employed to make bandages: 
among them are gauze, flannel, silk, linen, calico, unbleached 
muslin, crinoline, elastic webbing and India rubber. 

The material used to make the bandage should be so strong 
that it can be firmly applied and so supple that it can be neatly 
and smoothly adjusted to the part. Linen and silk are too 
expensive to be largely employed. ( Jalico is entirely too light, 
tears too easily and has too strong a tendency to crease. 
Gauze is frequently used. It is light, thin, soft and porous, 
can be nicely adjusted and makes equable compression. It 
is often employed to retain dressings on a wound, and when 
used for this purpose may be applied dry, or after it has been 
moistened with an antiseptic solution a moist gauze bandage 
can be applied with the greatest possible smoothness, nicety 
and speed; but it must never be put on very firmly because it 
tends to shrink. 

Flannel is a soft and elastic material, and makes an ex- 
cellent bandage for some purposes. It can be applied smoothly 
and evenly without making reverses, makes equable com- 
pression, absorbs moisture, and keeps the part warm. Flannel 
is often used to bandage the eye, to make abdominal binders, 
many-tailed bandages, "T" bandages, and bandages to be 
applied over rheumatic, gouty or sprained joints, and vari- 
cose veins of the leg. Flannel is also used to cover the ex- 
tremity to which plaster of paris is to be applied. 

Unbleached muslin is the material most frequently employed 
to make bandages which are to be used for holding splints in 

205 



206 TREATMENT OF EMERGENCIES 

place. A piece of this material from six to twelve yards long 
and one yard wide should be soaked for some time in water 
in order to cause it to shrink, also to cleanse it. It should 
then be dried and ironed. The free edge should be nicked 
with scissors at points which represent the desired width of 
the bandages, and the muslin should be torn into strips. Each 
strip should be freed from selvage by rapid shredding. If the 
selvage is allowed to remain, it will cause creases in the skin 
when the bandage is applied. A bandage should consist of 
one strip of muslin, as if two strips are sewed together a seam 
will be formed which will crease the skin. 

Crinoline is used to make plaster of paris bandages. The 
crinoline should be unwashed. Crinoline is a better material 
than gauze for making plaster of paris bandages, as the mesh 
of the crinoline holds the plaster more satisfactorily than 
gauze. 

Elastic webbing is used for a bandage when firm support of 
a part is desired. The bandage is comprised of a network of 
elastic which is covered with cotton or silk. The bandage per- 
mits the evaporation of perspiration, and for this reason is more 
advantageous than the bandage made of pure gum elastic. 

The India rubber, or gum elastic bandage, is used for the 
same purpose as the elastic web bandage. When the India 
rubber bandage is used, a flannel bandage should first be ap- 
plied to absorb the moisture. Both the elastic web bandage 
and the India rubber bandage are applied without reverses. 

A bandage can now be purchased which is made of cotton, 
woven in a manner to allow marked stretching. The bandage 
is used for the same purpose as an elastic web or India rubber 
bandage, but is less expensive, is lighter, more durable, is 
easily washed, has no odor, and permits evaporation. 

How to Make a Roller Bandage. — A roller bandage is made 
by taking a strip of one of the above-mentioned materials. 
The width and length depends upon the part to be bandaged. 
For the fingers, hand or toes the bandage should be one inch 
wide and three yards in length. For the arms and legs the 
bandage should be two and one-half inches wide and seven 
yards long. 

For bandaging the thigh, groin or trunk the bandage should 



BANDAGING 



207 



be three inches wide and nine yards long. For bandaging the 
head, the bandage should be two inches wide and six yards 
long. 

A bandage; should be free of seams and selvage to ensure 
neatness and comfort to the patient. A bandage may be 
rolled into a cylinder by means of a bandaging machine (Fig. 
117). In order to make a roller bandage by hand fold an end 




Fig. 117. — Foot roller-bandage machine (Fowler's Surgery). 



to the extent of six inches, fold this upon itself again and again 
until a small cylinder is formed. This center or cylinder 
should be tight to ensure a well-rolled bandage. This cylinder 
is now grasped with the thumb and index finger of the left 
hand. The free end of the bandage is then held between the 
index finger and thumb of the right hand. With the right 
hand the free end of the bandage is now revolved around the 
body of the bandage which is being held in the left hand (see 



208 TREATMENT OF EMERGENCIES 




Fig. 118. — First method for rolling a bandage. 




Fig. 119. — Second method for rolling a bandage. 



BANDAGING 



209 



Fig. 118). Some operators prefer to hold the body of the 
bandage in the right hand between the finger and the thumb 
and the free end of the bandage between the index finger 




Fig. 120. — Hand roller-bandage machine (Fo\vler*s Surgery). 




Fig. 121. — Method of starting a bandage. 

and middle finger of the left hand. The right hand is held 
practically stationary as the left hand revolves back and 
forth (Fig. 119). 

14 



210 TREATMENT OF EMERGENCIES 

The free end of the bandage is called the initial extremity, 
the end which is in the center of the bandage is the terminal 
extremity, and the rolled portion of the bandage is the body. 

Precautions for Applying Bandages. — To apply a roller 
bandage the external or outer surface of the initial extremity 
of the bandage is placed against the surface of the part to be 
bandaged. This end is held in place by the fingers of the left 
hand. The body of the bandage is held by the fingers and 
thumb of the right hand. As the bandage is applied, it un- 
winds from the body of the bandage which is held in the right 
hand (see Fig. 121). 

Apply each turn of the bandage with equal firmness. Do 
not have one turn tight and the next turn loose. Never leave 
a span of skin between the turns of a bandage. This will 
tend to pinch and cause great discomfort. 

Do not apply a bandage too tightly. The application of a 
tight bandage is not only uncomfortable, but may lead to 
gangrene of the part. 

Be especially careful to allow for the shrinkage of a bandage 
when applying a wet bandage, or when applying a bandage 
to hold a wet dressing in place. 

If the bandage is not long enough to cover the part desired, 
do not try to pull it a little tighter so as to make it serve, but 
finish the dressing with a second bandage. On the other hand, 
if you have completed your dressing and have part of your 
bandage remaining don't make a number of unnecessary turns 
in order to use up your bandage. When your dressing is com- 
pleted cut away the excess of bandage. See that the part 
to which you are to apply your bandage is in the position it is 
to occupy when the dressing is completed. For example, 
in applying a bandage to the elbow, bend the elbow to the 
desired position and thus apply the bandage. Do not bandage 
the elbow with the arm in extension and then when the band- 
age is completed flex the arm to a right angle. It will not 
only be an untidy dressing, but will be most uncomfortable, 
and may cause injurious pressure. 

Never apply a bandage to the forearm without including 
the hand, and never apply a bandage to the leg without includ- 



BANDAGING 



211 



ing the foot. This will prevent subsequent congestion and 
swelling of the hand or foot. 

Never apply a bandage so that skin surfaces are brought 
into contact — always place a piece of gauze or lint between 
the skin surfaces to prevent excoriation. 

When bandaging a joint, always protect the bony promi- 
nences with cotton. 

Should a part below the bandage become cold or blue, or 
should the patient complain of pain, tingling or numbness, 
remove the bandage at once. 




Fig. 122. — Method of removing a roller bandage. 

Inflamed tissues can stand but little pressure. 

Use especial care in applying a bandage to an infant or a 
child, as the tissues can bear but little pressure. 

Removal of a Bandage. — To remove a bandage start with 
the terminal extremity and unwind the bandage, gathering 
the turns loosely and passing the mass of unwound bandage 
from one hand to the other (Fig. 122). Bandage scissors to 
cut a bandage are shown in Fig. 123. 

It is extravagant to make a practice of cutting all bandages 
to remove them unless to do so ensures the patient less pain. 



212 



TREATMENT OF EMERGENCIES 



VARIETIES OF BANDAGES 

There are certain elementary bandages. The chief forms 
of simple bandage are the circular, the oblique, the spiral, 
the spiral reversed, the spica, the figure-of-eight, and the 
recurrent. 



r 






Fig. 123. — Bandage scissors. (Fowler's Surgery.) 

The chief forms of compound bandage are the single "T" 
the double "T, " the many-tailed, the four-tailed, and Mayer's 
handkerchief dressing. 

Slings, binders and fixed dressings must also be considered. 

Circular Bandage. — In order to apply a circular bandage a 
series of circular turns are made with a roller bandage around 
the part, each turn after the first overlying the turn beneath 




Fig. 124. — Circular bandage of wrist. 

it, and neither ascending nor descending. The circular band- 
age is used to keep a dressing on the wrist, the neck or the 
forehead (see Fig. 124). 

Oblique Bandage. — A series of oblique turns are taken 
around the extremity, ascending like the stripes on a barber's 



BANDAGING 



213 



pole; that is, the turns have between them an uncovered 
area. Practically the only uses for the oblique bandage are 
to loosely retain thick dressings which are applied for burns 
or scalds, and to hold in place temporary aseptic or antiseptic 
dressings (Fig. 125). 




Fig. 125. — Oblique bandage of the arm used only to hold dressings 
loosely upon the arm. 

Spiral Bandage. — The spiral bandage, which ascends or 
descends upon a part, is so applied that each turn overlies 
one-third the turn preceding. It is often applied to the fingers 
and to the chest, and sometimes to the abdomen. It is not a 
useful bandage to apply to an extremity, as it will not lie 




Fig. 126. — Spiral bandage of the arm. 

evenly. The reason is obvious. The circumference of an 
extremity becomes progressively greater as we near the body, 
and a spiral bandage is tight at the upper edge of each turn 
and loose at the lower edge, thus making unequal pressure 
and being certain to slip (Fig. 126). 



214 



TREATMENT OF EMERGENCIES 



Spiral Reversed Bandage. — The reverse enables us to cor- 
rect the inequality of the spiral bandage on an extremity, and 
by making careful reverses an extremity can be bandaged 
with the utmost neatness. The reverse is made in the follow- 
ing manner: The bandage is carried up the limb obliquely. 
The operator holds the unrolled portion with the thumb of 
his left hand, and with his right hand pulls upon the roller 
until there are about six inches of free bandage between the 




Fig. 127. — Making spiral reverse in bandage. 

thumb upon the extremity, and the cylinder itself (Fig. 127). 
This amount of free bandage is held slack and is folded upon 
itself, and the hand which carries the roller is taken under the 
limb and makes traction, thus causing the reverse to adjust 
itself accurately to the surface. This fold or reverse is accom- 
plished by changing the position of the right hand from super- 
nation to pronation (Fig. 128). Care should be taken to 
make the reverses in line. Reverses should not be made over 



BANDAGING 215 

bony prominences or joints, because these add too much to 
the pressure. See Fig. 185, spiral reverse of arm. 

The Spica Bandage. — In the spica bandage each turn 
crosses the antecedent turii/SO as to cover two-thirds of it, and 
the turns give the form of the Greek letter lambda. When 
the bandage is applied, it is supposed to resemble the leaves 
of an ear of corn. The spica bandage is applied to the shoul- 
der, the groin, the thumb, and the foot. 




Fig. 128. — Making spiral reverse of bandage. 

Figure-of-eight Bandage. — The turns resemble in shape the 
figure "8," and the bandage is very useful in covering joints 
and in bandaging the neck and axilla, or the head and neck 
(see Fig. 167). 

Recurrent Bandage. — The recurrent bandage covers a part 
by a series of turns, each one of which returns or recurs to its 
point of origin. In some cases (for instance in an amputation 
stump) the recurrent turns are covered by spiral or spiral re- 



216 



TREATMENT OF EMERGENCIES 



versed turns. The chief use of the recurrent bandage is to 
hold dressings upon the head and upon an amputation stump 
(see Fig. 157). 

The Single "T" Bandage. — This consists of a narrow piece 
of flannel, which is stitched or fastened by pins to a broad 
piece (Fig. 129, a single "T"). It may be used to retain 
dressings on the crotch, the anus or the scrotum, the narrow 
piece being fastened around the waist, and the broader piece 
being carried between the legs. A "T" bandage is occa- 
sionally applied to the chest. The horizontal portion goes 




Fig. 129.— Single "T" bandage. 

around the chest and is extremely broad, and the vertical por- 
tion goes over one shoulder and is narrow. A "T" bandage 
may also be used to fasten dressings on the groin. This is 
usually made of muslin, rather than flannel, the narrow 
horizontal strip passing around the waist, and a pyramidal 
strip crossing the groin and going around the thigh. This 
pyramidal strip is about thirty inches long and six inches 
wide at the base. 

The Double "T" Bandage.— The double "T" bandage is 
used on the chest in preference to the single "T." It is occa- 



BANDAGING 



217 




Fig. 130.— Double "T" bandage of the groin. 




Fig. 131. — Four-tailed bandage for dressing for fracture of the collar 

bone. 



218 



TREATMENT OF EMERGENCIES 



sionally used to retain dressings on the upper lip, on the nose, 
and between the eyebrows. When it is applied to the chest, 




Fig. 132. — The four-tailed bandage of the forehead and front of head. 




Fig. 133. — The four-tailed bandage of the top of head. 

the broad piece surrounds the chest, and the narrow strips pass 
over the shoulders like a pair of suspenders. It may also be 
used as a double "T" bandage of the groin (Fig. 130). 



BANDAGING 219 

The Many-tailed Bandage. — The length and width of the 
many-tailed bandage varies according to the region into which 
we desire to apply it. It is made of either muslin or flannel. 
The ends are torn almost to the center of the material, into the 
required number of tails. The four-tailed bandage comes 
under this heading. It is occasionally used to hold dressings 
on the scalp and upon the chin and ear, and as a temporary 
retentive apparatus in cases of fracture of the lower jaw. The 
four-tailed bandage for application to the lower jaw may be 
made from an ordinary roller bandage, four inches wide and 
one yard long, each extremity being torn up to within about 




Fig. 134. — Four-tailed bandage of tlio back of the head. 

two inches of the center. To make a four-tailed bandage for 
the scalp the muslin should be a yard and a quarter in length 
and eight inches in width, and tails should be torn in each end 
to within four inches of the center. This four-tailed bandage 
may be used to retain dressings on the forehead and front of the 
scalp (Fig. 132), on the top of the head (Fig. 133), on the back 
of the head (Fig. 134), or on the back of the neck (Fig. 135). 
A four-tailed bandage may be used to hold dressings upon the 
shoulder, as shown in Fig. 136. The four-tailed bandage may 



220 TREATMENT OF EMERGENCIES 




Fig. 135. — Four-tailed bandage of the back of the head and neck. 




Fig. 136. — Four-tailed bandage of the shoulder. 



BANDAGING 



221 



also be used as a temporary dressing in cases of fracture of the 
clavicle. The center of the bandage is placed around the el- 
bow, two of the tails go around the body, thus holding the arm 
to the side, and two of the tails pass over the shoulder of the 
uninjured side (Fig. 131). A bandage torn into many tails is 
often used to hold dressings on the chest or abdomen. In 
order to make a many-tailed bandage for the abdomen take a 
piece of flannel or muslin a yard and a half in length and two 
feet in width and tear eight tails on each side of it. The center 
of the bandage is applied to the patient's back, and the ends 




Fig. 137. — The triangular bandage used as a sling. 

are brought in front, and are successively overlapped and 
pinned in place. This bandage can be made to exert a con- 
siderable amount of pressure. 

Slings and Binders. — A sling is often made from an ordinary 
roller bandage, as shown in Fig. 131. The triangular sling is a 
much better appliance. In order to make a triangular sling, 
take a piece of muslin one yard long and one yard wide, and 
fold it into a triangle. Place the triangle under the limb with 



222 TREATMENT OF EMERGENCIES 

its apex projecting behind the elbow, and carry the portion of 
the triangle which is beneath the limb over the opposite 
shoulder. The other portion is carried over the near shoulder, 
and the ends are tied or pinned together behind the neck. The 
apex of the triangle is then pulled from in front of the elbow, 
and is pinned to the posterior portion. This sling gives sup- 
port to the hand, the forearm, and the elbow (Fig. 137). 




Fig. 138. — The triangular bandage used as a sling to hold the arm at 
an acute angle. 

The usual binder employed upon the abdomen is made of 
flannel one and a half yards long and two feet wide, and the two 
ends are fastened together with safety pins in front of the 
abdomen. As previously stated, some prefer the many-tailed 
binder. 

Mayor's Handkerchief Dressing. — This system of dressings 
was devised by Mayor, of Geneva, in 1838. He pointed out 
that if a square piece of cloth is taken, it can be folded in 
different manners, so as to permit us to apply it to various re- 
gions of the body. It is often useful in applying temporary 
dressings. The dimensions of the handkerchief vary according 



BANDAGING 



223 




Fig. 139. — The triangular bandage used as a suspensory bandage of 

the breast. 




Fig. 140. — Triangular bandage of the shoulder. 



224 TREATMENT OF EMERGENCIES 

to the region in which we wish to apply it. It may be made 
into a triangle, such as has previously been mentioned as the 
triangular sling (Fig. 137), or as a sling to hold the arm flexed 




Fig. 141. — The triangular bandage of the hand. 

at an acute angle, as in Fig. 138, a dressing useful in the treat- 
ment of injuries about the elbow joint. The triangle is used 
not only as a sling, but also to hold dressings upon the mam- 




Fig. 142. — The triangular bandage of the foot. 

mary gland (Fig. 139), and to hold dressings upon the shoulder 
(Fig. 140), the hand (Fig. 141), the foot (Fig. 142), the hip or 
one buttock (Fig. 143), both buttocks (Fig. 144), and the 



BANDAGING 



225 




Fig. 143. — The triangular bandage of one hip and buttock. 




Fig. 144. — Triangular bandage of both buttocks. 



15 



226 



TREATMENT OF EMERGENCIES 




Fig. 145. — Triangular bandage of the back of the chest and shoulders. 



. ' "■ ^ §111 




Fig. 146. — The triangular bandage of the head. 



BANDAGING 



227 




Fig. 147. — Triangular bandage of the chest. 




Fig. 148. — The cravat bandage used as an oblique bandage of the eye. 



228 TREATMENT OF EMERGENCIES 



v~ t 




Fig. 149. — The cravat bandage of the axilla or arm pit. 




Fig. 150. — Cravat bandage of the back of the head and neck. 



BANDAGING 



229 



posterior aspect of the chest or shoulders (Fig. 145), the head 
(Fig. 146), or the front of the chest (Fig. 147). 
The cravat is formed by taking the point of the triangle to 




Fig. 151. — The cravat bandage of the hand. 




Fig. 152. — The cravat bandage of the groin. 

the base and folding the material a number of times. The cra- 
vat is occasional^ used to make pressure upon some part, to 
support the hand as a sling, or to hold dressings in some region. 



230 



TREATMENT OF EMERGENCIES 




Fig. 153. — Barton's bandage for fracture of the jaw, applied with a 
cravat bandage. 




Fig. 154. — The occipito-frontal bandage or the bandage of the forehead 

and occiput. 



BANDAGING 231 

The cravat may be used to hold dressings over the eye (Fig. 
148), in the arm pit (Fig. 149), on the back of the neck (Fig. 
150), on the back of the hand (Fig. 151), in the groin (Fig. 152), 
or Barton's bandage made with a cravat, as in Fig. 153. 

The Bandage of the Back of the Head and Forehead. — This 
bandage is used to hold dressings on the back of the head or on 
the forehead. The bandage should be two inches wide and 
five yards long. Place the initial extremity of the bandage 
above the right ear and make a circular turn obliquely around 
the forehead above the left ear around the back of the head to 
the point where the bandage was started. Repeat this turn 
to fix the bandage. When the bandage reaches the back of the 
head on the second turn, it is carried forward around the fore- 
head, descending upon and overlapping one-half of the first 
turn. A third turn overlapping one-half of the second turn 
completes the bandage (Fig. 154). 

BANDAGING OF SPECIAL PARTS 
BANDAGES OF THE HEAD 

Barton's Bandage. — This bandage is used for fracture of the 
lower jaw; also to hold a dressing on the chin. 

The bandage should be six yards long and two inches wide. 
Place the initial extremity of the bandage at the nape of the 
neck below the bony prominence at the back of the head. 
Carry the bandage obliquely back of the left ear, across the 
top of the head, down in front of the right ear, under the chin, 
up in front of the left ear, and cross the first turn on top of the 
head directly in the midline. From the top of the head carry 
the bandage obliquely downward back of the right ear to the 
point where the bandage was started. The bandage is then 
carried directly forward under the left ear, around the front 
of the chin, back under the right ear, to the point from which 
the bandage was started. These turns should be repeated 
three times to insure firmness. The terminal end of the band- 
age is then fixed with a safety pin. The points where the 
turns of the bandage cross should also be fixed with adhesive 
plaster, or with pins (see Fig. 155). 



232 



TREATMENT OF EMERGENCIES 



Gibson's Bandage. — This bandage is used for fractures of 
the lower jaw. It is more difficult than the Barton bandage 
to apply, and no more satisfactory. 

The bandage should be two inches wide and six yards long. 
Place the initial extremity of the bandage in front of the left 
ear, carry the bandage across the top of the head, down in 
front of the right ear, under the chin to the front of the left ear 
where the bandage was started. Repeat this turn. When 
the bandage has reached the front of the left ear, having fin- 
ished the second turn, reverse the bandage and carry it for- 




Fig. 155. — Barton bandage for fracture of the jaw. 



ward around the forehead, back over the right ear to the nape 
of the neck, then forward above the left ear to the point 
where the turn was started in front of the left ear. Repeat 
this turn. When the bandage is carried to the nape of the 
neck on the second turn, carry the bandage forward under 
the left ear, around the front of the chin, back under the right 
ear to the nape of the neck. Repeat this turn. When the 
bandage has reached the nape of the neck for the second 
time, reverse the bandage and carry it directly over the top 
of the head to the forehead. Cut the bandage and secure 



BANDAGING 233 

the intersection of the turns with pins or adhesive plaster 
(see Fig. 156). 

Recurrent Bandage of the Head (Longitudinal). — This band- 
age is used to hold dressings on the head especially in the 
treatment of scalp wounds. The bandage should be two 
inches wide and seven yards long. Place the initial extremity 
of the bandage above the right ear. Carry the bandage around 
the forehead, back over the left ear, around the nape of the 
neck, forward above the right ear to the point where the band- 
age was started. Repeat this turn. When the bandage has 
reached the middle of the forehead on the third turn, the thumb 




Fig. 156. — Gibson's bandage for fracture of the jaw. 

or index finger of the left hand holds the free margin of the 
bandage; it is then reversed and carried over the top of the 
head in the midline to the nape of the neck. An assistant holds 
the bandage at this point. The bandage is again reversed 
and carried in an elliptical course to the forehead, each turn 
covering one-half of the prior turn. These turns alternate on 
either side, working away from the midline until the whole 
head is covered. The bandage is then completed by two cir- 
cular turns to fix the reverses of the bandage. Pins or adhesive 
plaster should be placed at the nape of the neck and at the 
forehead where the reverses were made. 



234 TREATMENT OF EMERGENCIES 

The test of a recurrent bandage is not to be able to pull it off 
the head by pulling it up from the neck. The main point of 
the bandage, therefore, is to carry it well down to the nape of 
the neck (see Fig. 157). The bandage may be applied with, the 
use of the double roller as shown in Fig. 158. 

The bandage can be greatly strengthened by pinning a strip 
of bandage to the circular turn in front of one ear, carrying this 
strip of bandage under the chin and fastening it to the circular 
turns just above the opposite ear as shown in Fig. 159. 




Fig. 157. — The longitudinal recurrent bandage of the head. 

Recurrent Bandages of the Head (Transverse). — This 
bandage is used to hold dressings on the head especially in the 
treatment of wounds of the scalp. The bandage should be two 
inches wide and seven yards long. Place the initial extremity 
of the bandage over the right ear and carry it forward around 
the forehead, back over the left ear to the nape of the neck, 
then forward to above the right ear where the bandage was 
started. Repeat this turn. When the bandage has reached the 



BANDAGING 235 

front of the right ear on the second turn, it is held by the thumb 
or index finger of the left hand. The bandage is then reversed 
and carried transversely across the head to the opposite ear. 
The bandage is held here by an assistant, is again reversed and 
carried back elliptically across the head, covering one-half of 
the first turn. These elliptical turns are made until the entire 
head is covered. The bandage is completed with two circular 
turns around the forehead and nape of neck. This should be 
applied to hold the reverses of the bandage. 




Fig. 158. — Starting a recurrent bandage of the head with the use of a 
double roller bandage. 

The Cross Bandage of One Eye. — This bandage is used to 
hold dressings over one eye. The bandage should be two 
inches in width and four yards in length. Place the initial 
extremity of the bandage above right ear and make two circu- 
lar turns around the head passing from the forehead to the 
nape of the neck. When the bandage reaches the nape of the 
neck on the second turn, it is carried under the ear on the side 
of the affected eye and is brought forward across the junction 



236 



TREATMENT OF EMERGENCIES 




Fig. 159. — Longitudinal recurrent bandage of head with chin strap. 




Fig. 160. — Transverse recurrent bandage of the head. 



BANDAGING 237 

of the nose with the forehead and carried over the opposite 
side of the head obliquely. Another circular turn is then made 
around the forehead to the nape of the neck. When the band- 
age is again brought to the nape of the neck, it is carried under 
the ear of the affected side and is again brought across the 
cheek over the affected eye covering one-half of the prior turn. 
It is carried obliquely across the opposite side of the head and 
back to the nape of the neck. These turns are repeated until 
the injured eye is completely covered. The bandage is com- 
pleted by a circular turn around the head. Pins are introduced 
to fasten the bandage (Fig. 161). 




Fig. 161. — Oblique bandage of one eye. 

Figure-of-eight or Crossed Bandage of Both Eyes. — This 
bandage is used to hold dressings or compresses upon both eyes. 

The bandage should be two inches wide and six yards long. 

Place the initial extremity of the bandage over the right 
ear and make two circular turns around the head from the 
forehead to the nape of the neck. When the bandage reaches 
the nape of the neck on the second turn, it is carried under the 
right ear, upward across the right cheek (the lower margin of 
the bandage crossing the junction of the nose with the fore- 
head), obliquely around the left side of the head, above the left 
ear, to the nape of the neck. From the nape of the neck the 



238 



TREATMENT OF EMERGENCIES 



bandage is now carried obliquely around the right side of the 
head, above the right ear, down across the left eye (the lower 
margin of the bandage crossing the junction of the nose with 
the forehead), across the left cheek, under the left ear, back to 
the nape of the neck. 

These turns are repeated, each turn covering one-half the 
previous turn, until both eyes are covered. 

The bandage is then completed by two circular turns around 
the head. 

Place pins at the intersections of the bandage (Fig. 162). 




Fig. 162. — The oblique bandage of both eyes. 



Oblique Bandage of Jaw. — This bandage is used to hold 
dressings on the jaw, on the side of the face, or on side of the 
head. 

The bandage should be two inches wide and six yards in 
length. 

If the right side of the face or the right side of the jaw is the 
part to be covered in, the initial end of the bandage should be 
placed above the right ear; then carry the bandage to the nape 
of the neck, above the left ear, to the forehead, back to the 



BANDAGING 



239 



initial end of the bandage. Make two such circular turns 
around the head. When the bandage reaches the nape of the 
neck on the second turn, it is carried under the left ear, under 
the chin, and up across the right cheek to the top of the head, 
keeping the anterior free margin of the bandage just back of 
the edge of the orbit. Carry the bandage across the head, 
down back of the left ear, under the chin, and again upward on 
the right side of the face, covering one-half of the prior turn. 
These turns across the right side of the face, over the head 




Fig. 163. — The oblique bandage of the left jaw. 

and back of the left ear are repeated until the right side of the 
face is covered in as far back as the ear. The bandage is 
then reversed when it reaches a point just above the ear, and 
two circular turns are made around the forehead and nape of 
neck. 

If the left side of the jaw, or left side of the face, is to be cov- 
ered in, the bandage should be started above the left ear; 
carry the bandage around the nape of the neck, above the 
right ear, to the forehead, then back to above the left ear, and 
fix the initial end of the bandage. Two such circular turns 



240 TREATMENT OF EMERGENCIES 

are made. When the bandage reaches the nape of the neck on 
the second turn, carry the bandage under the right jaw, under 
the chin, up across the left cheek, keeping the anterior free mar- 
gin of the bandage just back of the edge of the orbit. Carry 
the bandage across the top of the head, then down back of the 
right ear, then under the chin, and again upward on the left 
side of the cheek, covering one-half of the prior turn. These 
turns across the left side of the cheek, over the head, back of 
the right ear, under the chin, etc., are repeated until the left 
side of the face is covered as far back as the ear. The bandage 




Fig. 164. — Figure-of-eight bandage of the head and neck. 

is then reversed when it reaches a point just above the ear., and 
two circular turns are made around the forehead and nape of 
the neck. 

Secure the end of the bandage by means of pins, or by ad- 
hesive plaster (Fig. 163). 

"V" or Figure-of-eight Bandage of Head and Neck.— This 
bandage is very useful in holding dressings or applications to 
the back of the neck, and back of the head. 

The bandage should be two inches wide and five yards long. 

Make two circular turns of the bandage around the neck. 
On completion of the second turn, carry the bandage diagon- 



BANDAGING 241 

ally across the back of the head, above the right ear, around 
the forehead, above the left ear, across the back of the head, 
to the neck; take a circular turn around the neck and a second 
turn around the head. After a sufficient number of turns 
have been made, secure the end of the bandage with a pin or 
adhesive plaster (Fig. 164). 

"V" Bandage of Head and Jaw. — This bandage is occa- 
sionally used to hold dressings on the chin, or to either or both 
of the lips. 




Fig. 1G5. — The V-bandage of the head and chin. 

If a dressing is to be held upon the chin, or upon both lips, 
the bandage should be two inches wide and four yards long. 

Place the initial end of the bandage above the right ear 
and make two circular turns around the forehead and nape 
of neck. When the bandage has reached the nape of the neck 
on the second turn, it is carried under the right ear, around the 
chin, under the left ear, back to the nape of the neck. These 
turns alternate with the turns around the forehead. When a 
sufficient number of these turns have been made, the bandage 
is fixed with a pin or with adhesive plaster (Fig. 165). 



242 TREATMENT OF EMERGENCIES 

The bandage may be applied as a " V" bandage of the head 
and lip, as shown in Fig. 166. For this dressing the bandage 
should be one inch wide. 

If the dressing is to be applied to either lip or nose, the 
bandage should be one inch wide and four yards long. 

Figure-of-eight Bandage of the Neck and Axilla, or Arm 
Pit. — This bandage is used to hold dressing in the arm pit, on 
the side of the neck, or above the shoulder and collar bone. 

The bandage should be two inches wide and five yards long. 




Fig. 166. — The V-bandage of the upper lip and head. 

Make two circular turns of the bandage around the neck. 
If the right side of the neck or the right arm pit is to be band- 
aged, when the bandage has reached the back of the neck on 
the second turn, carry it forward across the right collar bone, 
under the right arm pit, over the shoulder to the front of the 
neck. Carry the bandage around the neck and repeat the 
turns under the arm pit. 

If the left arm pit or the left side of the neck is to be band- 
aged, after the circular turn of the neck has been made, the 
bandage is carried from the front of the neck, across the left 
collar bone, around the back of the shoulder, under the left 



BANDAGING 



243 



arm pit, ascending across the left collar bone and carried to 
the back of the neck. Then carry the bandage around to the 
front of the neck, where it is in position to repeat the turn 
over the shoulder, under the arm pit, etc. Each turn should 




Fig. 167. — Figure-of-eight bandage of the neck and arm pit. 

•overlap two-thirds the prior turn, the first turn being made 
well out near the tip of the shoulder. Complete the bandage 
by a circular turn around the neck. 

BANDAGES OF THE SHOULDER 

Spica Bandage of the Shoulder. — The spica bandage of the 

shoulder is used to hold dressings on the shoulder, and to hold 
a shoulder cap upon the shoulder in the treatment of a frac- 
ture of the upper portion of the humerus. 

The bandage should be two inches in width and eight yards 
long. 

The spica may be either ascending or descending. 

The Ascending Spica. — Make two circular turns around the 
arm as close to the arm pit as is possible. 

If the right shoulder is to be bandaged, carry the bandage 
across the front of the chest to the left arm pit, then around 



244 



TREATMENT OF EMERGENCIES 



the back of the chest to the right shoulder, crossing the first 
turn directly in the midline of the shoulder. The bandage is 
again carried around the arm, across the front of the chest to 
the left arm pit, around the back of the chest to the right shoul- 
der. Each of these turns overlaps one-half of the previous 
turn. 




Fig. 168. — Ascending spica bandage of the shoulder. 



Make a sufficient number of turns to cover in the shoulder. 
Then fix the end of the bandage with adhesive plaster, or with 
a pin. 

If the left shoulder is to be bandaged, after two circular 
turns have been made around the arm, the bandage is then 
carried around the back of the chest to the right arm pit, then 
around the front of the chest to the left shoulder, crossing the 



SAND AGING 245 

first turn in the midline of the shoulder. Each succeeding 
turn covers in one-half the prior turn (Fig. 168). 

The Descending Spica. — Make two circular turns of the 
bandage around the arm as close to the arm pit as is possible. 

If the right shoulder is to be bandaged, carry the bandage 
from the back of the arm pit, over the right shoulder blade, 
forward near the neck, to the front of the chest, then under 
the left arm pit, across the back of the chest to the base of 
the neck, where the bandage crosses the first turn. The band- 




Fig. 169. — The descending spica bandage of the shoulder. 

age is then carried under the right arm pit, and again over the 
shoulder to the front of the chest. Each turn descends upon 
the shoulder and covers in one-half the prior turn. The band- 
age is continued until the first circular turn around the arm 
is reached. The bandage is then secured by adhesive plaster, 
or with a pin (Fig. 169). 

Velpeau Bandage. — This bandage is used in the treatment 
of fractures of the collar bone and shoulder blade, and in dis- 
location of the shoulder. 

Instead of using one large bandage, it is handier to use two 



246 TREATMENT OF EMERGENCIES 

bandages, each two and one-half inches wide and seven yards 
long. 

The hand of the affected side should be placed on the oppo- 
site shoulder (Fig. 170). A piece of cotton or lint is placed in 
the arm pit of the affected side, a second piece in the bend of 
the elbow, and a third piece in the palm of the hand of the 
involved side. The initial end of the bandage is now placed 
over the shoulder blade of the sound side, the bandage is then 




Fig. 170. — The correct position of the hand and arm for the application 
of the Velpeau bandage. 



carried obliquely across the back of the chest to the tip of the 
shoulder of the injured side, then down the outer and posterior 
aspect of the arm, under the tip of the elbow (Fig. 171), 
across the front of the chest, to the arm pit of the sound side, 
then back to the shoulder blade of the sound side, thus fixing 
the initial end of the bandage. A circular turn is now made 
around the chest, which turn includes the affected arm. This 
turn is carried around the back to the elbow of the affected 
side. The lower margin of the bandage on this first circular 



BANDAGING 



247 




Fig. 171. — The first turn of the Velpeau bandage 




Fig. 172. — First turn of a Velpeau bandage. Note position of the 

hand. 



248 



TREATMENT OF EMERGENCIES 



turn should be on a line with the tip of the flexed elbow 
(Fig. 172). 

The bandage is carried from the elbow directly around. the 
chest to the back. Now carry the bandage across the shoulder 
of the affected side, covering one-half the prior turn ; continue 
the bandage down the outer and posterior aspect of the arm, 
under the tip of the elbow, across the front of the chest, to the 
arm pit, then to the shoulder blade of the sound side. Make 
another circular turn around the chest and arm, this turn 
covering in one-half the prior turn. 




Fig. 173. — The completed Velpeau bandage. 

Continue these alternating turns, first over the affected 
shoulder, then around the arm, until the vertical turns reach 
the base of the neck and the circular turns reach the upper level 
of the arm pit of the sound side; then fix the end of the bandage 
with adhesive plaster, or with a pin (Fig. 173). 

The Three-Roller Bandage of Desault. — This bandage is 
used for fracture of the collar bone. 

Three bandages are necessary for the application of this 
dressing. Each bandage should be two and one-half inches 



bandagim; 249 

wide and seven yards long. A wedge-shaped pad to fit in the 
axilla is also needed. 

The First Roller. — The wedge-shaped pad with its base in 
the arm pit is placed against the chest. The initial end of the 
bandage is placed upon this pad and a circular turn is made 
around the chest to fix the initial extremity of the bandage. 

The first roller of Desault is to hold the pad in place so 
additional ascending circular turns of the chest are made until 
the pad is held securely in place. The end of this roller is then 
fixed. 




Fig. 174. — The second roller of the Desault bandage. 

The Second Roller of Desault. — The arm of the affected 
shoulder is now brought firmly against the chest. It will be 
noticed that the pad acts as a wedge or fulcrum and tends to 
throw the shoulder away from the chest wall. The elbow is 
flexed and the forearm is brought to a right angle with the 
upper arm. 

The initial end of the second roller is now placed on the outer 
side of the affected arm, above the elbow; a circular turn is 
made around the chest and arm to fix the initial end of the 



250 TREATMENT OF EMERGENCIES 

bandage, then ascending spiral turns around the chest and arm 
are made to a height of the axilla of the sound side. The end 
of the second roller bandage is then fixed with a pin or with 
adhesive plaster (Fig. 174). 

The Third Roller of Desault.— The initial end of the third 
roller is placed over the shoulder blade of the sound side. The 
bandage is carried to the shoulder of the injured side, then 
down in front of the arm to the elbow of the injured side. It 
is carried underneath the elbow, diagonally across the back of 




Fig. 175. — The Desault bandage after the application of the three 

rollers. 

the chest to the arm pit of the sound side. The initial end is 
then fixed. 

The bandage is now carried from the arm pit of the sound 
side, across the front of the chest to the shoulder of the in- 
jured side. Here the bandage crosses the first turn on the 
shoulder directly in the midline. The bandage is now carried 
down the posterior aspect of the arm, underneath the elbow of 
the same arm, then diagonally across the front of the chest to 
the arm pit of the sound side. Three or four of these turns are 



BANDAGING 251 

made (Fig. 175). The end of the bandage is then fixed with 
adhesive plaster or a pin. The forearm of the injured side is 
then placed in a sling (Fig. 176). 




Fig. 176. — The completed Desault bandage. 

If the third roller has been applied correctly, it will be noticed 
that there are two triangles, one on the front of the chest, the 
other on the back of the chest. 

THE HAND AND FINGERS 

Spiral Bandage of the Finger. — This bandage is used to hold 
a splint upon the finger in case of fracture, "or to retain a dress- 
ing upon the finger in case of a wound. The bandage should 
be one inch wide and two yards long. 

Two circular turns are made around the wrist to fix the 
bandage. The bandage is then carried across the dorsum of 
the hand to the finger to be bandaged. Spiral turns are made to 
the tip of the finger. A circular turn is made at the tip of the 
finger. Then the bandage is carried to the base of the finger 
by spiral, spiral-reverse, or figure-of-eight turns. The bandage 
is then carried to the wrist, where two circular turns are made. 



252 TREATMENT OF EMERGENCIES 




Fig. 177. — The finger bandage. 




Fig. 178. — The demigauntlet. 



BANDAGING 253 

The proximal end is secured with adhesive plaster or with a pin. 

The bandage of the finger may be made neater and more 
secure if reverse turns are made over the end of the finger 
(Fig. 177). 

Demi-gauntlet Bandage. — This bandage is used to hold 
dressings upon the back of the hand. 

The bandage should be one inch wide and four yards long. 

The initial end of the bandage is fixed by two turns around 
the wrist. 




Fig. 179. — The gauntlet bandage. 

After the two turns around the wrist are made the bandage is 
carried across the back of the hand to the base of the little 
finger. The bandage passes around the base of the little 
finger and is then again carried across the back of the hand to 
the wrist, when another turn is made. The bandage is then 
carried across the back of the hand to the base of the ring finger, 
a turn is made around the base of the ring finger, and the 
bandage is then carried back to the wrist. 

The bandage is then terminated by a turn around the wrist 



254 TREATMENT OF EMERGENCIES 

and the distal end is fixed by a pin or with adhesive plaster 
(Fig. 178). 

The Gauntlet Bandage. — This bandage is used to hold dress- 
ings upon the fingers in the case of lacerations or burns. 

The bandage should be one inch wide and five yards long. 

Two turns of the bandage are made around the wrist. The 
bandage is then carried across the back of the hand to the base 
of the thumb. Carry the bandage by oblique turns to the tip 
of the thumb; cover the thumb by ascending spiral or spiral 
reverse turns. When the base of the thumb is again reached, 
carry the bandage to the wrist and make a circular turn 




Fig. 180. — Spica bandage of the thumb. 

around the wrist. The bandage is next carried across the 
back of the hand to the base of the index finger, and the 
index finger is covered in the same manner as the thumb. 

When all of the fingers have been covered, the bandage is ter- 
minated by a circular turn around the wrist. The distal end 
of the bandage is fixed by a pin or by adhesive plaster (Fig. 
179). 

Spica Bandage of the Thumb. — This bandage is used to hold 
a splint upon the thumb in case of fracture, to hold dressings 
upon the thumb, or to give support to the thumb when 
sprained or dislocated. 

The bandage should be one inch wide and three yards long. 

The bandage is fixed by two circular turns around the wrist. 



BANDAGING 



255 



It is then carried across the dorsum of the thumb and to the 
tip of the thumb by oblique turns. Two or three circular 
turns are made around the thumb until the web of the thumb 
is reached; the bandage is then carried across the dorsum of 
the thumb to the wrist, where a circular turn is made. The 
bandage is again carried across the dorsum cf the thumb, 
then around the thumb, and again carried to the wrist. These 
■ 




Fig. 181. — Bandage of the upper extremity. 

figure-of-eight turns are repeated, each turn covering one-half 
the prior turn until the entire thumb is covered in. The 
bandage is then completed by a circular turn around the wrist, 
the distal end being fixed by a pin, or by adhesive plaster. 



BANDAGE OF UPPER EXTREMITY 

This bandage is used to retain splints to the forearm, or to 
the upper arm, or to hold dressings upon the forearm or upper 
arm. 



256 



TREATMENT OF EMERGENCIES 



The bandage should be two inches wide and ten yards in length. 

Before starting the bandage, place the arm in the position it 
is to assume on completion of the dressing. In other words, if 
the upper extremity is to be dressed with the forearm at right 
angles to the upper arm, place the arm in this position before 
starting the bandage, and do not apply the bandage with the 




Fig. 182. — Figure-of-eight bandage of the elbow. 

arm in extension, and then, after completion of the bandage, 
place the arm in the right-angle position. 

Make two circular turns of the bandage around the wrist. 
Carry the bandage across the back of the hand and cover in the 
back of the hand with two or three figure-of-eight turns from 
the hand to the wrist. The bandage is then carried up the 
forearm by spiral turns until the muscles of the forearm are 
reached, when spiral reverse or figure-of-eight turns must be 



BANDAGING 



257 



made. If the elbow is at right angles and is to be bandaged, it 
is covered by means of figure-of-eight turns. The bandage is 
then continued on the upper arm with either spiral turns or 
spiral reverse turns until the arm pit is reached (Fig. 181). 

Figure-of-eight Bandage of Elbow. — This bandage is used 
to hold dressings upon the elbow. It is also used as a con- 
tinuation of the bandage of the fore- 
arm when the elbow is to be in- 
cluded in the bandage. 

The bandage should be two inches 
wide and five yards long. 

The elbow should be bent to the 
desired position. Two circular turns 
of the bandage are made around the 
forearm, a few inches below the elbow. 
The bandage is then carried in front 
of the bend of the elbow, around the 
upper arm a few inches above the 
elbow; here a circular turn is made. 
The bandage is then carried down 
across the front of the elbow, crossing 
the first turn in the bend of the elbow, 
to the forearm, where it overlaps one- 
half the prior turn. These figure-of- 
eight turns are repeated until the 
entire elbow is covered in (Fig. 182). 

The bandage may also be applied 
by first making a circular turn direct ly 
around the tip of the elbow ; the second 
turn descends toward the forearm, 
overlapping one-half of the first turn ; 

and the third turn ascends upon the upper arm, overlapping 
one-half the first turn. Then, the subsequent turns first 
descend upon the forearm, and then ascend upon the upper 
arm, each overlapping one-half the prior turn (Fig. 183). 

BANDAGES OF THE FOREARM AND ARM 

Circular Bandage of the Wrist. — This bandage consists of 
two or three circular turns around the wrist. It is occasionally 

17 




Fig. 183. — Figure-of-eight 
bandage of the elbow. 



258 TREATMENT OF EMERGENCIES 

used to retain dressings in this situation. The pure circular is, 
however, rarely used around the wrist, but such turns are fre- 
quently taken as the beginning of finger bandage, of a figure- 
of-eight of the hand and wrist, or of a bandage of the forearm 
which includes the hand (Fig. 124, page 212). 

Figure-of-eight Bandage of the Wrist and Hand. — The 
bandage should be two yards long and two inches wide. It is 
begun by making two circular turns about the wrist. It is then 
carried across the back of the hand into the palm, across the 




Fig. 184. — Figure-of-eight bandage of the wrist and hand. 

palm to the back of the hand, and across the back of the hand 
to the wrist at the point of origin. Several turns over this 
general route are taken, and each new turn covers half or two- 
thirds of the previous turn upon the back of the hand. The 
bandage is terminated by making a circular turn around the 
wrist. Its chief use is to retain dressings on the dorsum of the 
hand, the palm of the hand, or the wrist, and it is occasionally 
employed to make firm compression in this region. In former 
days it was frequently used in association with the graduated 



HAXDACiJNfi 



259 



compress, to make compression in cases of bleeding from one of 
the palmar arteries (Fig. 184). 

Circular Bandage of the Forearm or Arm. — This bandage is 
applied as is every other circular bandage, by making several 
successive circular turns about the part. It is not a suitable 
bandage to retain dressings, and is never applied with the idea 
of keeping it long in position. 

Oblique Bandage of the Forearm or Arm. — The bandage 
should be two yards long and two inches wide. It is begun 
by taking two circular turns around the hand, and it is then 
carried upward by very oblique turns to the elbow, or possibly 
to the shoulder, and is terminated by two circular turns. Such 
a bandage ascends obliquely, as does the stripes of a barber's 




Fig. 1S5. — The spiral reverse bandage of the forearm. 



pole, and a succeeding turn neither overlies, nor touches its 
predecessor. Practically the only uses of an oblique bandage 
are to retain bulky dressings in burn cases and to keep tem- 
porarily in place antiseptic dressings, during the time that a 
patient is being transported to a hospital, or when the dress- 
ings have been applied previous to an operation and must be 
speedily removed at an early period (Fig. 125, page 213). 

Spiral Bandage of the Forearm and Arm. — Such a bandage 
should be five yards long and two inches wide. It is begun 
by making a figure-of-eight of the wrist and hand. Spiral 
turns are then carried up the forearm, and the elbow is covered 
by figure-of-eight turns. The bandage ascends the arm by 
spiral turns and is terminated by a circular turn. It is occa- 
sionally used to retain dressings, but is an uncomfortable and 



260 TREATMENT OF EMERGENCIES 

unsatisfactory means of doing so. The upper edge of each turn 
lies closely in contact with the limb, and the lower is loose and 
not applied to the extremity. As a consequence, the bandage 
makes unequal pressure, produces furrows or welts in the skin, 
is decidedly uncomfortable, and is almost sure to slip. The 
impossibility of neatly adjusting a spiral bandage in this situ- 
ation is due to the conical shape of the limb (Fig. 126, page 
213). 

The Spiral Reverse Bandage of the Arm. — This bandage is 
used to hold dressings or a splint upon the forearm. The 
bandage should be two inches wide and six yards long. 




Fig. 186. — Figure-of-eight bandage of the forearm. 

The bandage is started as a figure-of-eight of the hand and 
wrist. The hand must be included in the bandage to prevent 
the hand from becoming swollen. The bandage is then carried 
around the wrist and the lower part of the forearm by spiral 
turns until the muscular part of the forearm is reached. 
Spiral reverses must now be made as described on page 259 
(Fig. 185). 

Figure-of-eight Bandage of the Forearm. — This bandage is 
used to hold a splint or dressing upon the forearm. It is easier 
to apply than the spiral reverse. The bandage should be two 
inches wide and six yards long. 

The bandage is started with a figure-of-eight of the wrist and 



BANDAGING 261 

hand. Spiral turns are made around the wrist and lower 
part of forearm. When the muscular part of the forearm is 
reached, the bandage is carried obliquely around the arm in its 
regular course. When the bandage is transferred to the oper- 
ator's left hand, the bandage is then brought down obliquely 
and crosses the first turn. These figure-of-eight turns are 
repeated until the elbow is reached, when the bandage is 
terminated with a circular turn (Fig. 18G). 

BANDAGE OF THE CHEST 

This bandage is used to hold dressings upon the chest, or 
upon the back. It is also used as a temporary dressing for 
fractured ribs until an adhesive plaster dressing can be applied. 

The bandage should be three inches in width and ten yards 
long. 

Two circular turns are made around the chest on a level with 
the lower margin of the ribs. The bandage is then carried up 
by ascending spiral turns upon the chest, each turn covering 
one-half the prior turn. When the spiral turns have reached 
the height of the arm pits, the bandage is carried under the 
left arm pit, across the back, over the right shoulder, and passes 
down over the front of the chest. Pins are placed at the several 
intersections of the bandage (Fig. 187). 

Anterior Figure-of-eight of the Chest. — This bandage is 
used to hold dressings on the front of the chest. 

The bandage should be two and one-half inches wide, and six 
yards long. 

The initial end of the bandage should be held in the right 
arm pit. The bandage is then carried diagonally across the 
front of the chest, over the left shoulder, close to the neck, 
under the left arm pit, across the front of the chest, crossing the 
first turn directly in the midline of the chest. Then carry 
the bandage over the right shoulder, close to the neck, under 
the right arm pit to the front where the bandage was started. 

These turns are repeated, each overlapping one-half the 
prior turn, the turns across the shoulders gradually approach- 
ing the tips of the shoulders from the base of the neck. After 
a sufficient number of such turns have been completed the 



262 



TREATMENT OF EMERGENCIES 




Fig. 187. — Roller bandage of chest with strap over shoulder. 



m"'i» 





Fig. 188. — Anterior figure-of-eight bandage of the chest. 



BANDAGING 263 

bandage is terminated, and the distal end fixed with a pin or by 
adhesive plaster. 

Bandage of Front of Neck and Chest. — This bandage is used 
to hold dressings on the front aspect of the chest at the upper 
border of the breast bone, or the lower portion of the front of 
the neck. The bandage should be two and one-half inches 
wide and six yards long. 

Two circular turns arc made around the neck. When the 
bandage reaches the front of the neck on the second turn, it is 
carried across the upper portion of the chest, under the left 
arm pit, around the back, under the right arm pit, and crc* 
the first turn of the chest diagonally to reach the opposite side 
of the neck. These turns across the chest and under the arm 
pits alternate with the turns around the neck. Each turn 
across the chest overlaps one-third of the prior turn. 

The bandage is completed with a circular turn around the 
neck and the distal (Mid is fixed with a pin or with adhesive 
plaster. 

Posterior Figure-of-eight of Chest— Thi< bandage is used 
to hold dressings upon the back of the chest between the 
shoulders. It may also be used as part of a dressing for 
fracture, of the clavicle. 

The bandage should be two and a half inches wide and six 
yards long. 

The subject to be bandaged stands with back toward the 
operator. The initial end of the bandage is placed in the left 
arm pit. The bandage is then carried diagonally across the 
back to the right shoulder, over the shoulder, passing close to 
the base of the neck, under the right arm pit, across the back of 
the chest, crossing the first turn in the midline. Then carry 
the bandage over the left shoulder, keeping close to the base of 
the neck, under the left arm pit to the point where the bandage 
was started. These turns are repeated, each one overlapping 
one-half of the prior turn. The turns across the shoulders 
gradually approach the tips of the shoulders from the base of 
the neck. 

After several turns have been completed, the bandage is 
terminated and the distal end fixed with a pin, or with adhesive 
plaster (Fig. 189). 



264 TREATMENT OF EMERGENCIES 




Fig. 189. — Posterior figure-of-eight bandage of the ehest. 




Fig. 190. — The first turn of the suspensory bandage of the breast. 



BANDAGING 



265 



Bandage of One Breast.— This bandage is used to hold 
dressings on or to support the breast in case of injury to, or 
inflammation of, the breast. 

The bandage should be two and one-half inches wide and 
seven yards long. 

The initial end of the bandage is placed under the breast to be 
bandaged (Fig. 190). If the right breast is to be bandaged, 
the bandage is then carried diagonally across the chest, over 

■ 




Fig. 191. — Suspensory bandage of breast. 

the opposite shoulder, keeping the bandage well out near the 
tip of the shoulder; carry the bandage across the back, under 
the arm pit of the affected side, to the front where the bandage 
was started. Repeat this turn to fix the bandage. When the 
bandage has reached the affected breast on the second turn, it 
is carried under the lower portion of the breast, directly across 
the front of the chest under the opposite breast, around the 
back, and is brought back to its starting point ; from here it now 
passes again across the front of the chest to the opposite 



266 TREATMENT OF EMERGENCIES 

shoulder, this turn overlapping one-half the prior turn. If the 
left breast is to be bandaged the bandage is carried from' the 
left breast under the right arm round the back, over the right- 
shoulder, across the chest, to the left breast. A turn is now 
made around the chest. These turns are repeated. 

The turns around the chest alternate with the turns over the 
shoulder, as each turn overlaps its predecessor. The breast is 
finally entirely covered in and supported. 




Fig. 192. — The suspensory bandage of both breasts. 

Fix the distal end of the bandage with a pin, or with adhesive 
plaster (Fig. 191). 

Bandage of Both Breasts. — This bandage is used to hold 
dressings upon, or to support both breasts in case of injury to or 
inflammation of both breasts. 

Two bandages will be needed, each two and one-half inches 
wide and six yards long. 

The initial end of the bandage is placed under the right 
breast and two circular turns are made around the chest, under 



BANDAGING 267 

the breasts, in order to fix the bandage. When the bandage 
has reached the right breast on completion of the second turn, 
it is carried under the breast, diagonally upward across the 
front of the chest to the left shoulder. It passes over the outer 
portion of the left shoulder, across the back, under the right 
arm pit, to a point under the right breast, where the bandage 
was started. The bandage is now carried across the front of 
the chest, under the left breast, under the left arm pit, diag- 
onally across the back, to the right shoulder, passing over the 




Fig. 193. — Sling bandage of the breast. 

outer portion of the right shoulder. It now passes diagonally 
across the front of the chest, under the left breast, and is then 
carried around the back of the chest to the right' breast, where 
the bandage is again carried over the same circuit. Each turn 
overlaps one-half the prior turn ; the turns across the shoulders 
extend from the tip of the shoulders to the base of the neck, 
and the circular turns of the chest ascend so that both breasts 
are entirely covered. 

The distal end of the bandage is fixed with a pin or with 
adhesive plaster (Fig. 192). 



268 TREATMENT OF EMERGENCIES 

Sling Bandage of Breast. — Another satisfactory suspensory 
bandage of the breast is applied as follows: Take a roller 
bandage of six yards long and two and one-half inches wide, 
place the initial extremity of the bandage under the breast to 
be bandaged and carry the bandage diagonally across the chest 
to the tip of the opposite shoulder. Carry the bandage under 
the arm pit of the same side, over the shoulder, then diagonally 
across the back to the arm pit of the affected side. Fix the 
initial extremity of the bandage. Repeat these turns six or 
eight times. Each turn ascends toward the arm pit and 
covers one-half the prior turn, thus suspending or supporting 
the affected breast (Fig. 193). 

BANDAGES OF THE LOWER EXTREMITY 

Ascending Spica of the Groin. — This bandage is used to hold 
dressings on the groin. The roller should be eight yards long 
and three inches wide. The bandage is begun by making two 
circular turns around the body at the crest of the pelvic bones. 
It is then carried downward across the groin to the inner por- 
tion of the thigh, if we are bandaging the right groin ; and down- 
ward across the groin and around the outer portion of the thigh, 
if we are covering the left groin. In either case the bandage is 
carried under the thigh and is taken upward as a figure-of-eight 
to the point of origin. A series of figure-of-eight turns is thus 
applied. Turns descend from the waist and turns ascend from 
the groin, until the groin is covered. The descending spica 
bandage is occasionally used instead of the ascending spica. 
It is applied in the same manner, except that the spica turns 
run downward toward the foot, instead of upward toward the 
waist. A number of surgeons in applying a spica bandage of 
the groin do not make any circular turns around the waist, but 
apply the bandage simply as shown in Fig. 194. 

Spica Bandage of Both Groins. — This bandage should be ten 
yards long and three inches wide. It is started with the cir- 
cular turns around the pelvis, is carried around the left thigh, 
is taken to the point of origin, and then is carried around the 
right thigh and taken to the point of origin, as is shown in the 
figure. A series of turns are thus applied, until the desired 



BANDAGING 269 

area is satisfactorily covered (Fig. 196). The bandage may be 
applied as in Fig. 195 without the original turn around the 
pelvis. 

Spica Bandage of the Buttock. — This bandage is used to 
hold dressings on the buttocks. The bandage should be eight 
yards long and three inches wide. Two circular turns are 
made around the thigh just below the crease of the buttocks, 
then the bandage is carried in an oblique direction upward 




Fig. 194. — Ascending spica bandage of the groin. 

and inward across the buttock, to above the pelvic crest on 
the opposite side. It is taken around the waist in a transverse 
direction, crosses the abdomen obliquely downward, and 
returns in this manner to its point of origin on the thigh. A 
series of ascending turns is thus applied, and the bandage is 
terminated by two circular turns around the waist (Fig. 197). 
A descending spica may be used instead of an ascending 
bandage. 



270 



TKEATMENT OF EMERGENCIES 



Figure-of-eight Bandage of Knees. — The bandage should 
be seven yards long and two and one-half inches wide. The 
knees are laid side by side, with a piece of lint interposed 
between them. Two circular turns are made below the level 
of the knee caps. The bandage then ascends obliquely across 
the front of the knees to the lower portion of the thighs, where 
two circular turns are made; a descending turn is then taken 
downward across the front, is caught under the knees, and 




Fig. 



195. — Double spica of both groins without the turn around the 
waist. 



returns to the point of origin. A series of figure-of-eight turns 
is made, ascending from below the knee, and descending from 
above the knee. The bandage is terminated by carrying it 
around the turns between the knees and is fixed by pinning it. 
Figure-of-eight Bandage of One Knee. — This bandage 
should be five yards long and two and one-half inches wide. 
Two circular turns are made around the leg below the lower 
margin of the knee cap. The bandage is carried to above the 
upper margin of the knee cap, two circular turns are made 



BANDAGING 



271 



around the thigh and the bandage returns to its point of origin. 
The turns from below, as they continue, ascend; and the 
turns from above, as they continue, descend. The point of 
the knee is covered in by one or two circular turns. The 
bandage is terminated either as a circular around the lower 
part of the thigh, as a circular around the upper part of the 
leg, or as a circular around the patella. 




Fig. 196. — Double spica bandage of the groins. 

The bandage of the knee may also be applied by making a 
circular turn directly over the knee cap. The second turn 
ascends and overlaps one-half of the first turn. The third 
turn descends and overlaps one-half of the first turn. These 
turns alternate, first ascending and then descending, until the 
entire knee joint is covered. The bandage is terminated by 
a circular turn below the knee and the distal end is fixed with 
a pin or with adhesive plaster (Fig. 198). 

Figure-of-eight Bandage of the Ankle. — This bandage 
should be five yards long and two inches wide. Two circular 



272 TREATMENT OF EMERGENCIES 




Fig. 197. — Spica bandage of the buttock. Fig. 198. — Bandage of 

the knee. 




Fig. 199. — Spica or figure-of-eight bandage of the ankle. 



BANDAGING 



273 




Fig. 200. — The ankle bandage with heel included (American method). 




Fig. 201. — Method of covering the heel in the bandage of the ankle. 



18 



274 TREATMENT OF EMERGENCIES 

turns are taken around the ankle, the bandage is carried down- 
ward in front of the ankle to the side of the foot, around the 
foot, and then upward in front of the ankle to the point of 
origin. The turns from above are made to descend, and the 
turns from below are made to ascend, and the foot, ankle and 
most of the hectare thus covered (Fig. 199). 

Bandage of the Foot Covering the Heel Known as the 
American Method. — The bandage should be eight yards long 
and two inches wide. It is begun by making two circular 
turns around the ankle. The bandage is then carried across 
the instep to the base of the toes, and at this point one or two 
circular turns are made. The bandage is then made to ascend 
upon the instep by two spiral reversed turns. From this point 
it is carried directly over the prominence of the heel and is 
brought back to the instep (Fig. 201). It is then taken under- 
neath the foot, around one side of the heel, and over the in- 
step again. Then it is carried beneath the foot, around the 
opposite side of the heel, and up in front of the ankle. From 
this point it is carried up the leg (Fig. 200). 

Bandage of the Foot, Not Covering the Heel, Known as 
the French Bandage. — Length and width of roller the same 
as the preceding. The bandage is begun by making two 
circular turns around the ankle. It is then carried across the 
instep to the ball of the foot, and two circular turns are made 
around the foot at the root of the toes. Two ascending spiral 
reversed turns are made upon the foot, and then the bandage 
is applied as a figure-of-eight around the ankle and instep. 
These figure-of-eight turns ascend upon the foot, but remain 
at the same level at the ankle. The bandage is then carried 
up the leg, the heel being left exposed (Fig. 202). 

Spiral Reversed Bandage of the Lower Extremity. — The 
bandage should be ten yards long and two and a half inches 
wide. This bandage may be begun as the spica bandage 
which covers the heel, as the American bandage which covers 
the heel, or as the French bandage which leaves the heel 
exposed. It is taken up the leg by ascending spiral reversed 
turns, covers the knee by figure-of-eight turns, ascends upon 
the thigh by spiral reversed turns, and is terminated by one or 
two circular turns (Fig. 203). 



BANDAGING 275 

Toe Bandage. — The bandage should be five yards long and 
one inch wide. Two circular turns are made above the ball 
of the foot, the bandage is then carried obliquely across the 
foot and around the affected toe; here a series of ascending 
spiral turns are made to the base of the toe, where the bandage 





Fig. 202. — Bandage of ankle without Fig. 203. — Spiral re- 

covering heel and method of making spiral verse bandage of lower 
reverse turns of the leg. extremity. 

is again carried around the ball of the foot at its termination 
(Fig. 204). 

Figure-of-eight Bandage of Leg. — A roller bandage ten 
yards long and two and one-half inches wide. The bandage 
is begun by two circular turns just above the ankle joint. 
It is then carried across instep to the ball of the foot, where 



276 



TREATMENT OF EMERGENCIES 




two or three spiral reversed turns may be made up the foot. 

A figure-of-eight of the ankle now carries the bandage to 
above the ankle joint, where the bandage 
is carried up leg by spiral turns. When 
the bandage reaches the calf muscles, 
where the diameter of the leg becomes in- 
creased, the bandage is carried up obliquely 
across front of leg to a distance of about 
three inches above last turns; here the 
bandage is carried 
around the leg, crosses 
the first oblique turn, 
and is carried around 
the leg, where the pro- 
cedure is repeated, 
each turn covering 
one-half of the previ- 
ous one. The bandage 
is terminated by circu- 
lar turns around leg 
-Bandage just below the knee 
(Fig. 205). 
Spica of Foot. — Roller bandage six to 

eight yards long and two and one-half 

inches wide. This bandage is begun by 

two circular turns around the leg just 

about the ankle joint. It is then carried 

obliquely across dorsum of foot to the ball 

of the foot, where onecircular turn is made. 

Now carry directly back and around point 

of heel, the edge of the bandage projecting 

somewhat below the inferior margin of the 

heel ; then bring forward again on opposite 

side of foot to the ball of the foot, and 

take a circular turn around the foot. 

This procedure is repeated. Each time 

the bandage is carried to the heel it covers 

one-half of the former turn, gradually 

working up over the ankle joint and each time bandage is 

returned to foot it covers one-half the previous turn. 



Fig. 204.- 
of the great toe. 




Fig. 205.— Figure- 
of-eight bandage of 
the leg. 



CHAPTER XV 
TRANSPORTATION 

The transportation of a disabled person plays an im- 
portant role in the instructions to the firemen. The follow- 
ing methods are those which are taught at the Training 
School for Firemen. Fig. 206 shows method of entering 
a building from an eighty-five-foot extension ladder. The 
bridging ladder is an eighteen-foot ladder. Figs. 207, 208, 
209, 210, 211, and 212 demonstrate the method of carry- 
ing a disabled person down a ladder. In Fig. 207 the victim's 
wrists are tied. Fig. 208 shows the rescuer having passed his 
head through the victim's tied anus. In Fig. 209 the rescuer 
now turns over and the victim is held on the rescuer's back. 
In Fig. 210 the rescuer is shown crawling toward the window. 
Fig. 211 demonstrates the manner in which the rescuer mounts 
the ladder from the window. Fig. 212 shows the rescuer 
descending with the victim. 

Fig. 213 demonstrates the Peerless head protector which 
is used by a fireman when entering an ammonia, gas, or smoke- 
charged building. 

Fig. 214 shows the manner in which an unconscious or dis- 
abled person may be passed from a window to the arms of a 
man on a ladder. 

Fig. 215 shows method of descending ladder with un- 
conscious person — the hands of the rescuer slide down the 
beams of the ladder. 

It is often necessar3 r to lower a disabled person from a roof 
or a window. Fig. 216 shows the method of fastening a rope 
around the victim, preparatory to lowering him from the roof 
or from a window. A running bowline is placed around the 
victim's thighs and a half hitch is taken around the victim's 
chest, the hitch being under the arm pit. The object of plac- 
ing the half hitch under one arm is to throw the victim's head 

277 



278 



TREATMENT OF EMERGENCIES 



to one side so that his head will not strike the side of the 
building, a window sill, etc. 




Fig. 206. — Manner of entering window from an extension ladder. 

The rescuer sits upon the rope and gently shoves the vic- 
tim over the edge of the roof. Sitting upon the rope serves 



TRANSPORTATION 



279 




Fig. 207* — Tying victim's wrists preparatory to carrying down ladder. 




Fig. 208. — Rescuer passes head through victim's tied arms. 




Fig. 209. — Rescuer turns on face with victim on back. 



280 TREATMENT OF EMERGENCIES 

as a brake. By moving the buttocks from side to side the 
speed of the rope can be regulated. 

Fig. 217 shows the victim being lowered from the roof. 

Fig. 218 shows two victims being lowered by use of block 
and tackle. 

In Fig. 219 the use of a guy rope is shown. This will pre- 
vent the victim, while being lowered, from striking the side of 
the building, wires, signs, etc. 

It is often necessary, when time will permit, to place a 
disabled person upon a ladder. This is accomplished as shown 
in Fig. 220. The victim is placed upon the ladder- (or board). 




Fig. 210. — Rescuer crawling to window — victim on back. 

The first hitch of the rope is a running bowline between the 
ankles and knees. The second is a half hitch around the 
ladder and both thighs (between the hips and knees), with the 
hitch on the under side of the ladder. The third is a half hitch 
around the ladder and chest, hitch being under the ladder. 
The fourth hitch is placed around the ladder above the vic- 
tim's head. The wrists of the victim are tied. It is a wise 
procedure to also cover the victim's face (if he be conscious) 
to prevent the psychic effect of being lowered from a height. 
A guy rope should be fastened to the running bowline around 
the victim's ankles. 



TRANSPORTATION 



281 




Fig. 211. — Mariner of mounting 
ladder with victim. 



Fig. 212. — Manner of descend- 
ing ladder with victim. Note 
method emploved by firemen to 
hold ladder steady. 



282 



TREATMENT OF EMERGENCIES 




Fig. 213. —Use of Peerless Head Protector for rescuer. 



TRANSPORTATION 



283 




Fig. 214. — Method of passing Fig. 215. — Descending ladder with 
an unconscious person from win- an unconscious person, 

dow. 




Fig. 216. — Method of fastening rope around person about to be lowered 



284 TREATMENT OF EMERGENCIES 

Fig. 221 shows method of passing ladder from window. 

Fig. 222 shows victim being lowered. 

It is often necessary for a person to lower himself down a 
rope from a roof or window. To attempt to slide down a rope 
causes severe brush burns of the hand after descending but a 
few feet, the hands relax their hold and the man drops. The 
proper way of lowering oneself down a rope is -shown in Fig. 
223. The rope is wrapped about the right leg. It is im- 
portant that the rope pass from the inner side of the right 
groin. Wrap the rope once around the right leg and have 




r 



Fig. 216a. — Preparatory to lowering person from roof. 



the rope extend across the instep of the right foot. The left 
foot is then placed so that it holds the rope tightly against the 
right instep. The rope, thus held between the arch of the 
left foot and the instep of the right foot, acts as a brake to 
regulate the speed of descent. The man then lowers himself 
"hand over hand." 

Fig. 225 shows the correct way to hold a life net and the 
correct preparation of a man about to jump into a life net. 
The coat is tied around the neck in order to prevent the sudden 
backward jerk of the head and neck when a man lands in the 
net. 



TRANSPORTATION 



285 




Fig. 217. — Person being lowered from roof. 



286 



TREATMENT OF EMERGENCIES 




Fig. 218. — Method of lowering two victims. 



TRANSPORTATION 



287 




Fig. 219. — Showing use of guy rope. 



288 



TREATMENT OF EMERGENCIES 




Fig. 220. — Method of tying victim to ladder or board to lower from 
window or roof. 



TRANSPORTATION 



289 



■■■■ % 
h m ' 


\i 


wjEmm, 


■ 


mil* S-^^~ :! 


--'. 


— ■_ 




Fig. 221.— Method of passing 
victim out of window. 



Fig. 222. — Victim being lowered. 



19 



290 



TREATMENT OF EMERGENCIES 




Fig. 223. — Correct method of fixing rope to lower oneself from roof. 



TRANSPORTATION 291 

Fire Carry. — Fig. 226 demonstrates the first step of the fire 
carry. The patient should be raised to the sitting posture. 
The bearer now puts his right arm around the patient's right 
thigh, if it be a man, or around both thighs if the patient be a 
woman, the patient lying across the bearer's back. The 
bearer's left hand grasps the patient's right wrist. The 
bearer then lifts the patient and holds him as in Fig. 228. 
It will be noted that the bearer's left hand and arm are entirely 
free. 



V 




Fio. 224. — Correct method of placing injured man on stretcher. 

Carrying Pick-a-back. — Fig. 229 shows method of carrying 
a conscious person pick-a-back. 

Assisting Patient to Walk. — Fig. 230 shows method of 
assisting a patient to walk. The bearer stands alongside of 
the patient and places the patient's arm around bearer's neck, 
the bearer's shoulder being in patient's arm pit, and the 
patient's wrist being held around bearer's neck. The bearer's 
other arm encircles the patient's waist. 

Two-handed Seat. — The patient lies on his back. The 
two bearers kneel on either side of the patient. (Kneel on 
the knee nearest to the patient's feet.) Each bearer passes 
one arm under the patient's thighs, grasping each other's 
wrists, the other arm being put around the patient's back, and 
the wrists are grasped. Raise the patient to a sitting posture, 
then lift patient to bearers' knees (Fig. 231). The bearers 
then slowly rise. 



292 



TREATMENT OF EMERGENCIES 




Fig. 225. — Correct method to hold life net and correct method to jump 

into net. 



TRANSPORTATION 



293 




Fig. 226. — Fire carry. First step. 



294 



TREATMENT OF EMERGENCIES 




Fig. 227. — Fire carry. Second step. 



TRANSPORTATION 



295 




Fig. 228.— Fire carry. Third step. 



296 



TREATMENT OF EMERGENCIES 



£ k 


LL ... . -a 




Fig. 229. — Carrying pick- 
a-back. 



Fig. 230. — Method of assisting injured 
man to walk. 



TRANSPORTATION 



297 




Fig. 231. — The two-handed seat. 




Fig. 232.— The three-handed seat. 



298 



TREATMENT OF EMERGENCIES 




Fig. 233. — The four-handed seat. 



TRANSPORTATION 



299 



The bearers' arms, with clasped wrists, which were around 
patient's back, may be shifted so that each of the bearers' 
hands rest on the others shoulder as in Fig. 234. The 
patient places an arm around each of the bearers' necks. 

Three-handed Seat. — The three-handed scat is made as in 
Fig. 232. The bearers kneel on either side of patient, kneeling 
on knee nearest patient's feet. The seat is slipped under 
the patient's thighs. The right free arm of the bearer to the 
left of the patient is placed around the patient's back and 




Fig. 234. — Carrying a victim in a two-handed seat. 



rests upon the other bearer's shoulder, forming a support 
against which patient may lean. The patient places an arm 
around the bearers' necks. 

Four-handed Carry. — The seat is made as shown in Fig. 
233. The bearers kneel on either side of patient, kneeling 
upon the knee nearest to the patient's feet. The seat is slipped 
under the patient's thighs. The patient places an arm around 
the bearers' necks, and the bearers then slowly rise. 



300 



TREATMENT OF EMERGENCIES 



Carrying by The Extremities. — One bearer stands at the 
patient's head and raises patient to a sitting posture.- The 
bearer's arms are then passed under the patient's arm pits 
and are clasped across patient's chest. The second bearer 
stands between the patient's thighs and passes an arm around 
each of the patient's thighs, above knees, and then clasps his 
own wrists as shown in Fig. 235. 




Fig. 235. — Carrying by the extremities. Not to be practised when the 
back or extremities have been injured. 



STRETCHERS 

Fig. 236 shows collapsible stretchers. 

Stretchers may be improvised by the use of a ladder, door, 
window shutter, cot, board, or hammock. 

A blanket stretcher is shown in Fig. 240. A blanket is 



TRANSPORTATION 



301 




Fig. 236. — Collapsible stretchers used on Fig. 237. — Splint 

Philadelphia Police Patrol Wagons. stretcher in use (Rixey 

in Keen's Surgery). 



302 



TREATMENT OF EMERGENCIES 




Fig. 238. — Stretcher used on police patrol wagons. 




Fig. 239. — Stretcher used on police patrol wagons. 



TRANSPORTATION 



303 




Fig. 240. — Blanket stretcher. 



304 



TREATMENT OF EMERGENCIES 



placed upon the ground. Two strong poles, each about 
seven feet long, are placed lengthwise on either side of the 
blanket. The poles are now rolled in the edges of the blanket 
until the unrolled portion of the blanket is about two feet and 
a half wide. Five or six holes are made in the blanket near 
each pole, and rope or cord is passed through each hole and 
tied around the pole. A stick at either end of the blanket 
fastened to the poles holds the poles apart. 




Fig. 241. — Method of making stretcher with blanket. 



A quicker method of making a blanket stretcher is shown 
in Fig. 241 and Fig. 242. 

Fig. 241 shows blanket stretched upon ground, with pole 
lying across center of blanket. Fig. 242 shows the stretcher 
completed. 

The Coat Stretcher. — The coat stretcher is shown in Fig. 
243. The sleeves of the coat are turned inside out. The coat 
is buttoned. The poles are passed through the inverted 



TRANSPORTATION 



305 



coat sleeves. Instead of using poles, rifles or shot guns may 
be used. The muzzles of the guns should point in the same 
direction. When using guns for this purpose it must be certain 
that neither gun is loaded. 

Chair Stretcher. — A chair maybe used as a litter or stretcher. 
The patient sits in the chair. The two bearers place them- 
selves on either side of the chair. The chair and patient are 




Fi< 



!42. — Blanket stretcher. 



carried as shown in Fig. 244. If necessary to cam- the patient 
up stairs or up an incline, always carry with the back of the 
chair going first. 

Transferring a Patient from Stretcher to Bed. — The method 
of transferring a patient from a stretcher to a bed is shown 
in Fig. 245. The head end of the stretcher rests upon the 
foot of the bed. The bearers then lift the patient as shown 
in Fig. 245. 

20 



306 TREATMENT OF EMERGENCIES 

Several Rules for Carrying a Stretcher. — The stronger of 
the two bearers should carry the head of the stretcher. 

The bearers should walk "out of step" — walking "in step" 
swings the stretcher and jolts the patient. 

The head of the patient should rest upon a pillow or folded 
coat, unless the patient is in the state of "shock," in which 
case the head should be lower than the feet. 

The patient should be carried "feet first." 




Fig. 243. — Coat stretcher. 

Carry the stretcher as near the ground as possible. Do not 
carry the stretcher on the shoulders, and do not run. 

When carrying a stretcher bearing a patient suffering with 
a broken leg up a hill or up steps, always carry "feet first," 
so that the weight of the body will not push upon the broken 
limb. When carrying a patient with such an injury down a 
hill or down steps carry "head first." 

Keep the stretcher as nearly level as possible. 

Motor-cycle Stretcher. — A motor-cycle devised for carrying 
stretcher is shown in Fig. 246 and Fig. 247. 



TRANSPORTATION 



307 




Fig. 244. — Chair stretcher. 




Fig. 245. — Method of transferring patient from stretcher to bed. 



308 



TREATMENT OF EMERGENCIES 




Fig. 246. — Motor-cycle with stretcher. 



TRANSPORTATION 



309 




Fig. 247.— Roar view of motor-cycle designed to carry stretcher 



CHAPTER XVI 



POISONS AND THEIR TREATMENT 



A poison may be taken by accident, or may be taken with 
suicidal intent, or given for homicidal purpose. 

The greatest care should be used in keeping any drug which 
is poisonous. Many bottles are kept in the medicine closet. 
Unless those bottles which contain poisonous substances can 
be identified not only by sight, but also by touch, a mistake 
is likely to occur. To avoid such accident, all boxes, bottles 
or containers of any poisonous drug should be conspicuously 
labeled, and the container should be of such a form that it 
will immediately be recognized as a container of a poison (see 
Figs. 248 and 249). 





Fig. 248. — Bottle with poison- 
guard (J. P. C. Griffith). 



Fig. 249.— Poison-bottle (J. P. 
C. Griffith). 



All boxes or bottles the contents of which are not positively 
known should be destroyed. 

Never allow a bottle or a box of any drug within the reach 
of a child. 

All unconscious persons should be carefully searched, and 
the room in which a victim is found should be searched for 

310 



POISONS AND THEIR TREATMENT 311 

the evidence of a bottle or box which may have contained a 
poisonous substance, and which may have been the cause of 
the victim's unconsciousness. 

General Consideration of Treatment. — Ascertain if possible 
what drug has been taken. Save any material which may be 
vomited, for the physician's inspection when he arrives. 

If the victim has not vomited, empty the stomach by the 
use of an emetic, or by a stomach pump; give the antidote for 
t he poison, if the poison be known ; and t real the const it ut iona! 
effects of the poison. 

The passage of the stomach tube or pump requires some 
practice, and should never be used in poisoning by a mineral 
acid or alkalies. In strychnine poisoning the stomach tube 
or pump may only be used prior to the onset of the convulsions. 
The stomach can, however, be emptied by an emetic. The 
best household remedies which may be used as emetics are 
warm water and salt, or warm water and mustard. Two to 
four tcaspoonsful of either mustard or table salt to a glass of 
warm water is usually efficient. 

Ipecac may be given in the dose of one-half to two teaspoons- 
f nl of the syrup or wine of ipecac to a child — a tablespoonful 
for an adult. 

Zinc sulphate as an emetic is chiefly employed in narcotic 
poisoning, that is, from opium, morphine, etc. The dose is 
from ten to thirty grains in a glass of warm water. This 
dose may be repeated in fifteen minutes to half an hour, if 
necessary. 

Copper sulphate is more prompt and more powerful than 
zinc sulphate. Copper sulphate is especially serviceable in 
phosphorus poisoning, as it not only empties the stomach, 
but also acts as a partial antidote by forming an insoluble 
phosphid of copper. The dose is five to ten grains in a glass 
of warm water. If this amount is not effective, it is best not 
to repeat the dose, but give another emetic. 

Alum is a safe emetic, but is somewhat uncertain. The 
dose to a child is a teaspoonful given in syrup. This dose may 
be repeated once or twice, if necessary. 

Apomorphine is a most efficient emetic, but is best admin- 
istered by hypodermic injection, and, therefore, only to be 



312 TREATMENT OF EMERGENCIES 

given by the direction of a physician. It is most useful when 
swallowing is impossible, or when the condition of the stomach 
will not warrant the use either of a mechanical or irritant 
emetic. It is very useful in acute alcoholism. Because 
of the decreased sensitiveness of the medullary center, it 
may prove inactive in narcotic poisoning. Apomorphine 
should not be given to the very young, nor to the infirm, as 
considerable depression may attend its administration. The 
dose is from one-twelfth to one-fourteenth hypodermatically. 
It will induce vomiting if given by mouth in larger doses, but 
its action, being central, is delayed when so given. 

After the stomach is emptied, the antidote to~ the poison 
should be given in order to counteract any of the poison which 
has not been vomited. 

The general condition of the patient must then be treated. 
The patient may be shocked, in which case stimulants, such 
as brandy, whiskey, or hot coffee, may be necessary. The 
patient must be kept warm; hot water bottles should be 
applied. 

If severe pain be present, morphine, paregoric or laudanum 
must be given. 

METALS 

Arsenic (Arsenious Acid, Fowler's Solution, Cheap Ices, 
Vermin Killer, Rat Poisons, Paris Green, and Donovan's 
Solution). Two and one-half grains have proved fatal. The 
symptoms are those of acute inflammation. The symptoms 
usually occur within fifteen minutes to a half hour after the 
drug has been taken. There is acute pain and burning in 
the stomach; vomiting, at first of food, becoming mucous and 
then bloody, and mixed with bile. The severe vomiting and 
diarrhea naturally cause great thirst. Severe purging follows 
vomiting. The purging is similar to that of cholera, and is 
often bloody. The symptoms of shock are present. The 
extremities are cold. The face is blanched. There are cold 
sweats. The pulse is weak and rapid. Exhaustion and 
death follow. 

Treatment. Empty the stomach by means of an emetic 
or stomach tube, or pump. Then wash the stomach out with 



POISONS AND THEIR TREATMENT 313 

large quantities of soapy water. Dialyzed iron is the anti- 
dote, and should be given in one-ounce doses. Follow this 
by large doses of olive oil. Pain may be relieved by the ad- 
ministration of morphine or opium. If depression or shock 
is present, the patient must be freely stimulated, and warmth 
and friction are applied to the body. 

A hot water bag to the abdomen is beneficial. 

Antimony (Tartar Emetic, Wine of Antimony). The 
smallest fatal dose is three-fourths of a grain. The symp- 
toms usually occur within a half hour after the drug has been 
taken. There is a metallic taste in the mouth. Vomiting 
is severe and sometimes bloody. There is severe abdominal 
pain, purging which is often involuntary, and cramps in the 
legs with occasional tetanic spasms of the limbs. The skin 
is cold, and later the face becomes cyanotic. The urine is 
suppressed. Delirium and convulsions may occur, followed 
by depression and collapse. 

Treatment. — The stomach is usually well emptied by vomit- 
ing. If not, a stomach tube should be used. Strong coffee or 
tea or a half teaspoonful of tannic or gallic acid in a half glass 
of water should be given. Demulcent drinks of white of an 
egg in water, barley water, or milk should also be given. 
Stimulants are administered, if collapse is present. The 
patient is kept warm and treated as for shock. 

Copper {Blue Vitriol, Blue Stone). — Canned fruit which is 
contaminated with copper as well as food cooked in copper 
vessels have been known to produce the poisoning. The acute 
poisoning is not common. The symptoms are immediate 
and violent vomiting. The vomitus is blue. There is acute 
pain in the upper part of the abdomen. The purging is severe, 
the nervous system is often affected, there being spasms and 
even convulsions similar to tetanus. Jaundice may occur. 
The patient has symptoms of shock and finally collapses. 

Treatment. — If the stomach has not been emptied by vomit- 
ing, give an emetic or use the stomach pump. Then give a 
large quantity of milk or the white of eggs in water. This 
should be followed by barley water, arrowroot or gruel at 
frequent intervals. Stimulate as symptoms arise and apply 
hot poultices to the abdomen. 



314 TREATMENT OF EMERGENCIES 

Lead (Sugar of Lead, Lead Acetate, Goulard's Extract). — 
Acute poisoning by lead is rare and seldom fatal. The chronic 
poison is common among painters. Symptoms of acute 
poison usually occur within a few minutes after the drug has 
been taken. There is a metallic taste in the mouth and a 
foul odor on the breath. Vomiting and retching are very 
obstinate, and the vomitus is sometimes blood-streaked. 
The pain is usually colicky and may be relieved by pres- 
sure. The pain is usually around the umbilicus. The bowels 
are usually constipated but may be relaxed. The nervous 
symptoms consist of headache, shooting pains and cramps in 
the legs and occasionally paralysis or convulsions. 

Treatment. — The stomach should be emptied by an emetic 
or by the use of the stomach tube. One-half teaspoonful of 
dilute sulphuric acid or one ounce of magnesia sulphate should 
then be given. This should be followed at frequent intervals 
with demulcent drinks. Pain may be relieved by hot poultices 
applied to the abdomen. 

Silver Nitrate (Lunar Caustic). — Acute poisoning is very 
rare. It has occurred, however, from swallowing sticks of 
silver nitrate. The symptoms are pain in throat, mouth 
and abdomen followed by vomiting and diarrhea. The 
mucous membrane of the mouth is stained white. 

Treatment. — The stomach should be emptied by means of 
an emetic and a tablespoonful of salt in a glass of water should 
be given at frequent intervals. 

Zinc (Burnett's Disinfecting Fluid, Zinc Chloride, White 
Vitriol). — The symptoms are those of an acute irritant. 
There is pain in the throat, burning of the lips and throat 
followed by vomiting, purging and abdominal pain. There 
is usually loss of voice. There may be convulsions and mus- 
cular weakness followed by collapse, coma and death. 

Treatment. — The stomach should be emptied and large doses 
of carbonate of soda in water should be given. Solutions of 
tannic acid, strong tea or milk and eggs are also beneficial. 
Heat should be applied to the abdomen. Stimulate, if shock 
be present. 

Mercury (Mercuric Chloride, Corrosive Sublimate, Calomel, 
Blue Mass). — The smallest fatal dose of mercury has been 



POISONS AND THEIR TREATMENT 315 

three grains of bichloride. The symptoms are immediate 
and violent burning of the throat on swallowing. Death may 
occur immediately from edema of the glottis. The mucous 
membrane of the mouth and throat is stained white. There is 
nausea and vomiting. The vomitus is streaked with blood. 
Following vomiting there is severe bloody purging. The 
temperature drops below normal and collapse ensues. 

Treatment. — The stomach should be emptied cither by 
means of an emetic or the stomach tube. The antidote is 
the white of eggs or milk. Demulcent drinks, such as barley 
water or flour and water, should be given. Apply heat to 
the abdomen and stimulate freely. 

ACIDS 

Sulphuric Acid (0/7 of Vitriol). — The local effect causes a 
discoloration of the skin, which is first white and then brown. 
The effect upon the skin is not unlike a scald or a burn. If 
the dose taken is a large one, and is taken on an empty stomach, 
the stomach may be dissolved and the acid find its way to the 
peritoneal cavity. In such a case the patient usually dies 
within a few hours. The symptoms an 4 those of shock. 
associated with symptoms of perforation of the stomach and 
peritonitis. A smaller dose causes severe and persistent vomit- 
ing, which may be bloody. Then 4 is acute pain and a strang- 
ling sensation. Death may occur from a spasm of the glottis. 
Pieces of mucous membrane from the glottis or the stomach 
may be vomited. 

Treat went. — The mineral acids, alkalies and strychnine are 
the only poisons for which the use of the stomach pump or 
emetics are inadmissible. The sulphuric acid should be 
neutralized by giving an alkali, such as magnesia, chalk, 
plaster from the wall, powdered crayons, soap suds, soda or 
lime water, then give demulcent drinks, such as barley water, 
milk or the whites of eggs. One-fourth pint of olive oil should 
be given. If any acid has been inhaled, have patient inhale 
fumes of ammonia. 

Nitric Acid. — Poisoning from nitric acid differs very slightly 
from poisoning from sulphuric acid. Nitric acid, however, 
forms a gas when it comes into contact with organic matter. 
This greatly adds to the suffering. 



316 TREATMENT OF EMERGENCIES 

Treatment. — The treatment is the same as that for sulphuric 
acid poisoning. Tracheotomy may have to be performed if 
inhalation of the fumes of ammonia does not counteract the 
effect of the nitric acid. 

Hydrochloric Acid. — The symptoms of hydrochloric acid 
poisoning differ little from the poisoning of the other mineral 
acids. The main distinction of hydrochloric acid poisoning 
is the absence of corrosion of the skin. Therefore, in any case 
of suspected poisoning by acid, should there be stains on the 
face or mouth, the probability is that the poisoning is not that 
of hydrochloric acid. 

Treatment. — The treatment is the same as that for nitric 
or sulphuric acid. 

Oxalic Acid (Salts of Lemon). — The poisoning from oxalic 
acid is very rapid in its action. There is a burning pain in 
the mouth, and a sensation of constriction about the throat. 
It causes a severe inflammation of the stomach. A large dose 
may cause abortion. 

Treatment. — Neutralize the acid by giving either chalk or 
limewater. Do not give sodium bicarbonate, or ammonia, 
as the alkaline oxalates are extremely poisonous. Stimulate 
if necessary, and give one ounce of castor oil. 

Tartaric Acid and Acetic Acid. — Poisonings from these acids 
also produce a burning sensation in the mouth, and a feeling 
of constriction in the throat. 

Treatment. — Give an alkaline, such as baking soda, mag- 
nesia, or lime water, and follow by a tablespoonful of castor 
oil. 

Carbolic Acid (Creosote, Phenol). — Carbolic acid is a deadly 
poison, and a poison which is often taken for suicidal purpose. 
There is immediate burning in the mouth, throat, and stomach. 
There is an odor of carbolic acid on the breath. Vomiting is 
severe and persistent. White eschars are present upon the lips 
and the mouth. Symptoms of shock quickly follow. There is 
difficulty in breathing. The respirations bceome shallow, the 
pulse thready and the skin is covered with cold, clammy sweat. 
The patient becomes unconscious. The urine is usually 
cloudy, and of a green or blackish hue. 

Treatment. — The stomach pump should not be used because 



POISONS AND THEIR TREATMENT 317 

of the destruction of mucous membrane. The antidote is 
alcohol, or some soluble sulphate, such as epsom salts or 
(dauber salts. Alcohol may be given in the form of whiskey 
or brandy. This should be followed by the white of eggs in 
milk, olive oil, or a tablespoonful of castor oil. Stimulate 
freely and apply hot water bags to the extremities, and treat 
the associated shock. 

Phosphorus. — Phosphorus is present in matches, in vermin 
killer and in rat poisons. When phosphorus is taken, there is 
immediate and intense pain in the throat and the odor of 
phosphorus upon the breath. Retching and vomiting are 
severe. The vomitus is tinged with blood and is luminous in 
the dark. Jaundice may ensue. There may also be painful 
cramps in the extremities, and occasionally convulsion-. 
Great effusion of blood from the nose, mouth, bladder or bowels 
may occur. 

Treatment. — The stomach should be emptied by means of 
the stomach pump, or the stomach tube, and should be 
washed out with a 1 to 1000 solution of potassium perman- 
ganate (fifteen grains of potassium permanganate to a quart of 
warm water). Give demulcent drinks, such as milk, etc. Do 
not give any oils or fats as they aid in the absorption of the 
poison. Treat existing shock. 

ALKALIES 

Ammonia {Vapor of Ammonia). — There is burning sensation 
in the eyes. There is burning of the throat, a sense of suffoca- 
tion, giddiness, nausea and vomiting. 

Treatment. — Remove the patient to the fresh air and hold 
a rag saturated with vinegar close to the patient's nose. Be 
prepared to do a tracheotomy if edema of the glottis occurs. 

Taken Internally. — When ammonia is taken internally, 
there is burning of the mouth, and of the stomach, followed 
by a marked redness and swelling of the lips and mouth. 
There is retching and vomiting. Breathing becomes difficult 
and symptoms of shock are manifested. 

Treatment. — Do not attempt to use a stomach pump. Give 
weak acid, such as vinegar, lemon juice, or dilute hydrochloric 
acid. Later give the white of eggs beaten in milk, olive oil, 



318 TREATMENT OF EMERGENCIES 

or castor oil. Stimulate freely, and be prepared to do a 
tracheotomy if necessary. 

Caustic Potash (Sodium Potash (Lye), Potassium Nitrate 
(Salt Petre), Calcium (Lime). — Poisoning from these is treated 
the same as poisoning from ammonia. 

VOLATILE LIQUIDS 

Paraffine (Kerosene). — The symptoms of poisoning are 
those of odor of the oil on the breath and in the vomitus ; there 
is pain in the stomach; the patient seldom vomits without an 
emetic; symptoms of shock ensue and coma may follow. 

Treatment. — Give an emetic, or wash out the stomach with 
a stomach tube or stomach pump. Stimulate freely and apply 
heat to the extremities. 

Oil of Turpentine. — Symptoms of poisoning are those of 
intoxication, giddiness, purging and strangury. The pupils 
are contracted. There may be convulsions and coma. The 
urine has an odor of violets, and contains blood and albumin. 

Treatment. — Empty the stomach by an emetic, the stomach 
pump or stomach tube. Give demulcent drinks, such as 
milk, etc., and apply hot fomentations in the region of the 
kidneys. 

Alcohol. — First Stage. — The first stage of poisoning by 
alcohol indicates cerebral excitement, incoherent or exagger- 
ated speech, giddiness and inability to walk properly. The 
face and eyes are flushed. There is an odor of alcohol upon 
the breath. 

Second Stage. — At the second stage the face becomes pale, 
the eyes are staring, the pupils dilate and react sluggishly 
to light, the skin is cold and clammy; stupor is followed by 
coma; the temperature is subnormal; in children convulsions 
are usually present. 

Treatment. — The stomach should be emptied by a stomach 
pump or stomach tube and should be washed out with hot 
coffee. A physician may give apomorphia, excepting to a 
child or a feeble person. Keep the patient warm. 

Chloroform. — Chloroform, when taken as a liquid, causes 
a burning sensation in the mouth and stomach. This burn- 
ing sensation is followed by numbness. The patient becomes 



POISONS AND THEIR TREATMENT 319 

excited and possibly delirious. This is followed by narcosis, 
with symptoms of shock. The patient may arouse himself 
and vomit bloody mucus, and suffer severe abdominal pain. 
Convulsions may follow. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube or an emetic. Wash out the stomach 
with coffee, and give a coffee enema. Arouse the patient and 
give large quantities of water. Administer artificial respiration 
if necessary. 

The symptoms of chloroform, when taken as a vapor, are 
in three stages. 

First Stage. — The patient is in a drunken condition. There 
are hallucinations, and the patient struggles; the pupils are 
contracted and the face is flushed. 

Second Stage. — This stage is that of narcosis. The patient 
is in a deep sleep; the reflexes are l<>si ; respiration is slow; the 
pulse is full and slow; the pupils are dilated: the muscles are 
relaxed. 

Third Stage. — There is complete muscular paralysis; the 
pulse is weak and irregular; the pupils are widely dilated; 
respiration is shallow; the lips are cyanotic. 

Death may occur in any one of the three stages, but usually 
in the third stage. 

Treatment. — See that the patient gets plenty of fresh air. 
Loosen the clothing. Keep the tongue forward, and apply 
artificial respiration. Slap the face and chest in the region of 
the heart with a wet towel. Apply an electric battery. 
Stimulate freely. 

Ether. — Poisoning by vapor of ether is practically the same 
as that of chloroform, excepting in the heart action. Ether 
at first stimulates the heart and the after-depression is never 
as great as that in poisoning by chloroform. 

Treatment. — The treatment is the same as that of poisoning 
from the vapor of chloroform. 

NARCOTICS 

Opium {Morphine, Laudanum, Paregoric, Dover's Powder, 
Heroin, Many Soothing Syrups, and Cough Medicines). — 
Symptoms of poisoning are manifested in three stages. 



320 TREATMENT OF EMERGENCIES 

The first stage is that of excitement. The heart is stimu- 
lated, the mentality is quickened, the face is flushed, and 
the pupils are contracted. If taken in larger doses there may 
be vomiting. 

The second stage is that of drowsiness and stupor. There 
is an urgent desire to sleep, but the patient can be aroused in 
this stage. Pulse and respirations are slower. 

The third stage is that of deep sleep. The patient can not 
be aroused; the skin is cold and clammy; the respirations be- 
come slow, occasionally not more than six or eight per minute ; 
the pupils are markedly contracted, giving them what is known 
as a "pin point pupil;" the pulse is slow. 

Treatment. — Potassium permanganate in a solution of 
fifteen grains to a quart of water should be used to wash out 
the stomach. Even if the morphin has been given with a 
hypodermic or if the opium is already in the circulation, the 
drug is reabsorbed by the stomach and the stomach must be 
washed out. Give an emetic, or use the stomach tube or 
stomach pump, and wash the stomach out with hot coffee, 
leaving a pint of hot coffee in the. stomach. Do not allow the 
patient to sleep, but attempt to keep the patient awake by 
slapping with a towel or by an electric battery, but do not try 
to walk the patient, as overexhaustion may be harmful because 
of the depression of the heart. Atropine is administered by a 
physician. Allow the patient to inhale fumes of ammonia. 
Administer artificial respiration if necessary, or use the lung- 
motor or pulmotor. 

Chloral. — Chloral is the ingredient of many of the so-called 
"knock-out drops." It is also an ingredient of many sleeping 
potions. The symptoms of poisoning in moderate doses are 
those of sleepiness, which can be overcome by the patient 
himself. In large doses, the narcosis is uncontrollable. The 
temperature is subnormal. The pulse and respirations are 
slow and weak. The skin is cold and clammy. 

Treatment. — The stomach should be emptied by an emetic 
or by the stomach pump or stomach tube, and the stomach 
should be washed out with hot coffee, leaving a pint of hot 
coffee in the stomach. Keep the patient awake by slapping 
with a towel or by the use of an electric battery. Stimulate 



POISONS AND THEIR TREATMENT 321 

with strychnine, brandy or whiskey. Administer artificial 
respiration if necessary. 

Excito-motor (Nux Vomica, Strychnine, Brucine). — Symp- 
toms are those of great irritability and nervousness, especially 
to external stimulus, such as noise, door slamming, etc. This 
irritability is followed by convulsions, which are tonic in 
character. The whole body becomes rigid, the head is drawn 
back and the body is arched, so that the patient rests upon 
his head and his heels. This convulsion lasts for several 
minutes and then subsides, leaving the patient exhausted. 
A slight noise, or a slight jar to the bed, is likely to induce 
another convulsion. The pupils are dilated. The pulse is 
rapid and feeble. The face is congested. The eyes are 
prominent and staring. Death usually occurs from asphyxia, 
or from collapse. 

Strychnine poison resembles lock-jaw. In lock-jaw, how- 
ever, the locking of the jaw is one of the early symptoms. 
In strychnine poisoning the locking of the jaw is a later symp- 
tom. In lock-jaw there is practically no relaxation of the 
muscles in between the convulsions, whereas in strychnine 
poisoning there is a distinct period of muscular relaxation be- 
tween the convulsions. 

Treatment. — The stomach pump can only be used in a case 
where the patient is seen early, before the convulsions occur, 
as if an attempt is made to use the stomach pump or stomach 
tube after the convulsions have begun the use of the tube or 
pump will excite another convulsion. Give an emetic, such 
as mustard, zinc sulphate, or apomorphia. Give a half 
teaspoonful of tannic acid in a cupful of water. Keep the 
patient quiet, in a dark room, free from any noise or draft. 
Give large doses of chloral (thirt}' grains). If unable to 
administer chloral or bromides by mouth, administer bj T the 
rectum. It may be necessary for a physician to control the 
convulsions by administering chloroform. 

Belladonna (Atropine, Deadly Xightshade). — Belladonna is 
used in many liniments. Atropine is used to dilate the pupils 
before testing the eyes for glasses. The symptoms of poison- 
ing are those of nervousness and excitability. The patient 
may be delirious. The face is flushed, and the pupils are 
21 



322 TREATMENT OF EMERGENCIES 

widely dilated. The throat is dry and there is great thirst. 
The skin is flushed. The vision is disturbed. There may be 
clonic convulsions. There is lack of coordination and often 
double vision. The patient staggers if he attempts to walk. 

Treatment. — The stomach should be emptied by means of 
the stomach pump, the stomach tube, or an emetic. Mor- 
phine or opium is the antidote, but should be cautiously given 
and only by a physician. Keep the patient quiet, and if the 
patient becomes exhausted stimulants may be necessary. 

Cocaine. — The symptoms of poisoning by cocaine are those 
of cerebral excitement, nervousness, excitability, and a feeling 
of grandeur. There may be vomiting. This stage of cerebral 
excitement is followed by a stage of depression. The pulse is 
at first quickened, but later becomes feeble and slow. The 
skin is pale. Death usually occurs from paralysis of the 
breathing centers. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or an emetic. Stimulate the patient 
if necessary. Also administer artificial respiration. 



DEPRESSANTS 

Aconite (Monk's-hood, Wolfs-bane, Blue Rocket). — Aconite 
is an ingredient of many liniments and of fever mixtures. 
The symptoms of poisoning are those of a sweetish taste in the 
mouth, followed by a burning and tingling sensation in the 
mouth and face, extending later to the whole body. The 
respirations are labored. The pulse is weak and irregular. 
The skin is cold and moist. There is a burning sensation in 
the stomach, followed by vomiting, retching and diarrhea. 
The pupils are dilated. There is dimness of the vision, or 
complete blindness. There may be convulsions or paralysis. 
Death is usually due to asphyxia or prostration. 

Treatment. — The stomach should be emptied by means of 
the stomach pump, the stomach tube, or an emetic. Strong 
tea or coffee should be left in the stomach. Treat the patient 
as for shock. Stimulate freely with whiskey, brandy, strych- 
nine or atropine. Administer artificial respiration if necessary. 



POISONS AND THEIR TREATMENT 323 

MISCELLANEOUS POISONS 

Coal-tar Products. — Aspirin, Acetanilid, Phenacetin, Anti- 
pyrin, Antikamnia, Bromo-Seltzer. — The coal-tar products 
are used in many headache powders. The symptoms are 
those of weak and rapid pulse, with a sensation of lightness 
in the head. The extremities are cold, the face and lips are 
livid, or even cyanotic. The temperature is subnormal. 
Respirations are shallow and labored. There is marked 
depression. 

Treatment. — The stomach should be emptied. The patient 
should be kept quiet and should be stimulated with whiskey, 
brandy or strong hot coffee. Keep the patient's body warm. 
Administer artificial respiration if the respirations become 
labored or cease. 

Cantharides. — Spanish Flies. — Cantharides is the ingredient 
used in many fly blisters. The symptoms of poisoning when 
the drug is taken internally are those of burning sensation in 
the mouth, throat and stomach; abdominal pain; diarrhea; and 
strangury. There is marked salivation and difficulty in swal- 
lowing. There is intense pain over the kidneys and frequently 
bloody urination. The pulse is rapid. There is headache and 
dizziness, and occasionally delirium or convulsions. There i> 
sexual excitement. Women often abort. 

Treatment. — The stomach should be emptied by the stomach 
pump, or stomach tube, or by an emetic. Administer large 
quantities of demulcent drinks, such as the white of eggs and 
milk, barley water, etc. Place hot applications over the blad- 
der and over the kidneys. A physician may give morphine 
or opium to allay pain. 

Oil of Almonds (Hydrocyanic Acid, Potassium Cyanid, 
Prussic Acid). — Hydrocyanic acid is a deadly poison. One 
drop of the pure acid, if taken when the stomach is empty, is 
sufficient to cause death. The symptoms appear very soon 
after taking. There is dizziness, nausea and occasionally 
vomiting. This is followed by insensibility. The eyes are 
fixed and staring. The face is cyanotic. The respirations are 
characterized by a short inspiration and prolonged expiration. 
The pupils are dilated. Convulsions may ensue. Death 
usually comes from paralysis of the respiratory centers. 



324 TREATMENT OF EMERGENCIES 

Treatment. — The stomach should be emptied by means of 
the stomach pump, the stomach tube, or by an emetic. Ad- 
minister artificial respiration and stimulate freely. Keep the 
patient warm. 

Muscarin, Mushrooms, Fly Fungus.— The symptoms usu- 
ally follow the eating of a poisonous mushroom. Symptoms 
are those of nausea and vomiting, with severe abdominal 
pain and diarrhea. The pulse is weak. The skin is cold and 
clammy, and is bathed in a profuse prespiration. Muscular 
weakness and collapse may follow. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or by an emetic. Give a large dose 
of castor oil. Keep a hot water bag on the abdomen. A phy- 
sician may give opium or morphine if pain is severe, also to 
Gheck the diarrhea. Apply external heat and stimulate freely. 

Ptomaine Poisoning. — Ptomaine poisoning is usually due 
to eating tainted fish, lobsters, meat, cheese, ice cream, etc. 

The symptoms are those of nausea, vomiting, abdominal 
pain and diarrhea. In children there may be convulsions. 
In a severe case the patient is shocked. 

Treatment. — The stomach should be emptied by means of 
the stomach pump, the stomach tube, or by an emetic. 
Apply a hot water bag to the abomen. A physician may give 
opium or morphine to allay the pain and check the diarrhea. 
Give a large dose of castor oil. Stimulate if necessary, and 
apply external heat. 

Gases (Sewer Gas, Marsh Gas, Carbonic Acid Gas, Charcoal 
Fumes, Carbon Monoxide, Water Gas, Coal Gas). — Symptoms. 
— There may be a choking sensation, followed by giddiness, 
headache, nausea and muscular weakness. There is drowsi- 
ness and ringing in the ears. There may be vomiting. Con- 
vulsions are sometimes present. In the last stage of the 
poisoning the pulse is rapid and irregular, respirations are 
hurried and shallow, the face is cyanotic, the patient is 
unconscious. 

Treatment. — Remove the patient to the fresh air. Give 
oxygen; administer artificial respiration, if necessary; allow 
the patient to inhale the fumes of ammonia; stimulate freely 



POISONS AND THEIR TREATMENT 325 

by mouth, if the patient is able to swallow. If the patient is 
unable to swallow, give stimulants by rectum. 

Croton Oil. — Croton oil is a powerful irritant. The symp- 
toms of poisoning are severe abdominal pains, vomiting and 
severe purging, followed by symptoms of shock. The skin 
is cold and clammy; the face is pinched; the pulse is rapid and 
small; collapse soon occurs. 

Treatment. — The stomach should be emptied by means of the 
stomach pump, the stomach tube, or by an emetic. Give 
demulcent drinks, such as milk, barley water, white of eggs, 
etc. A physician may give opium, morphine, or paregoric to 
allay pain. Stimulate the patient freely, and apply external 
heat. 

Iodine. — Poisoning by iodine causes a burning sensation in 
the throat and leaves a yellow stain about the mouth. The 
burning sensation is followed by vomiting and purging, and 
abdominal pain. The vomitus is yellow or brown. There is 
dizziness. Occasionally convulsive movements are present. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or an emetic. Starch is the antidote. 
Give flour and water, barley and water, or arrowroot and 
water in large quantities. Allay the pain with opium, 
morphine, or paregoric, and stimulate if necessary. 

Ergot. — The symptoms of ergot poisoning are nausea, 
vomiting, intense thirst, coldness of the skin, headache, and 
stupor. The pulse is slow in the early stages, but later grows 
rapid and feeble. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or by an emetic. Stimulate freely, 
and apply external heat. 

Iodoform Poisoning. — Iodoform must be used with caution, 
especially in the dressing of large wounds. Some people are 
susceptible to iodoform and after its prolonged use the drug 
may produce severe symptoms. The symptoms are those of 
nausea, fever, watery eyes, -hallucinations, delirium, 3 T ellowness 
of the skin and eyes, and the odor of iodoform upon the breath. 
Headache is usually present. The patient developing iodo- 
form poisoning may pass into a coma and die within a week. 



326 TREATMENT OF EMERGENCIES 

If death does not occur there may be loss of memory or severe 
nervous phenomena. Acute mania may ensue. 

Treatment. — The use of the drug should be stopped at once. 
Favor the elimination of the drug by producing sweating, by 
laxatives, and by diuretics. Sustain the strength of the 
patient by stimulants. 

Hyoscyamus (Henbane). — Poisoning by hyoscyamus pro- 
duces a feeling of excitement and giddiness, often followed 
by delirium and coma. The pupils are dilated. The vision 
may be doubled. The mouth is dry, and there is great 
thirst. 

Treatment. — Empty the stomach by use of the stomach 
pump, stomach tube, or by an emetic. Stimulate the patient 
if necessary. 

Camphor Poisoning (Gum Camphor). — Camphor is an 
ingredient of many liniments. Poisoning by camphor causes 
mental excitement, headache, and dizziness. There is severe 
abdominal pain. Collapse may occur. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or an emetic. Apply a hot water 
bag to the abdomen, and stimulate the patient if necessary. 

Cannabis Indica (Hashish, Indian Hemp). — In poisonous 
doses it produces a state of mental excitement, associated with 
hallucinations, and disordered consciousness of time, locality 
and personality. This stage is followed by a stage of profound 
sleep. The senses are often benumbed. The circulation and 
respirations are little involved by the drug. 
. Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or by an emetic. Try to arouse the 
patient by slapping with a towel, or by an electric battery. 
Stimulate, if necessary, with whiskey, brandy, or hot coffee. 

Colchicum. — Colchicum is used in many of the prepara- 
tions for gout and rheumatism. The symptoms of poisoning 
are those of severe abdominal pain, vomiting and purging. 
Prostration and collapse ensue. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or by an emetic, and give tannic acid 
(a teaspoonful in a glass of water). Apply hot water bag 
to the abdomen, and stimulate the patient. 



POISONS AND THEIR TREATMENT 327 

Conium (Hemlock). — A poisonous dose of conium produces 
nausea, vomiting, diarrhea and salivation. There is muscular 
weakness, and the patient staggers on attempting to walk. 
There may be complete paralysis. The pupils are dilated. 
Unconsciousness is preserved until near the end. 

Treatment. — Empty the stomach by means of the stomach 
pump, the stomach tube, or by an emetic. Give a teaspoonful 
of tannic acid in a glass of water. Stimulate with whiskey, 
brandy or hot coffee. 

NECESSARY FOR EMERGENCY OR RECEIVING WARD FOR 
TREATMENT OF POISONS 

1. Stomach tube and pump — ready for immediate use. 

2. Jar epsom salts. 

3. Castor oil. 

4. Emetics, (a) mustard; (h) sulphate of zinc; (c) ipecac; 
(d) apomorphia. 

5. Ammonia and ammonia salts. 

6. Vinegar. 

7. Olive oil. 

8. Milk. 

9. White of eggs. 

10. Flour, barley, rice, arrowroot all in water. 

11. Coffee extract. 

12. Dialysed iron or hydrated oxide of iron. 

13. Electric battery. 

14. Tannic or gallic acid. 

15. Pearls of amyl nitrite. 

16. Laudanum and paregoric. 

17. Croton oil. 

18. Saccharated limewater. 

19. Chloroform and ether. 

20. Tracheotomy set. 

21. Hypodermic with apomorphia, pilocarpine, strychnine, 
morphine, atropine, etc. 

22. Brandy and whiskey. 

23. Sol. apomorphine hydrochlorate (2 per cent.) dose as 
emetic Tfl,v to x. 

24. Large poison chart with each poison and antidote 
together with brief method of procedure. 



CHAPTER XVII 
HOUSEHOLD REMEDIES 

Medicines when given in liquid form and on an empty 
stomach are more readily absorbed than medicines taken in 
the form of pills or powders or medicine taken after eating. 

Powders are more quickly absorbed than pills. 

Never attempt to look for medicine, nor to administer 
medicine in the dark. Be sure you are giving the correct 
medicine and the correct dose. 

All bottles containing poisonous medicines should be kept 
in bottles easily recognized by touch, as well as, by sight 
(page 310). 

Never attempt to guess at the dose of a drug. If you are 
not sure, don't give the medicine until you are informed by 
one who knows. 

Equivalents. — One drop equals one minim. 

Sixty drops equals one teaspoonful. 

One teaspoonful equals one dram. 

One dessertspoonful equals two drams. 

Two dessertspoonfuls equals one tablespoonful. 

One tablespoonful equals one-half ounce. 

Contents of one tumbler equals eight ounces. 

Contents of two tumblers equals one pint. 

Contents of four tumblers equals one quart. 

Use of Cold and Heat. — Local Use of Cold. — The local use 
of cold in the form of an ice bag or ice compresses should not 
be too intense and should not be applied too long. It should 
not be used on tissues which are devitalized from injury, nor 
if the patient is old or in an exhausted condition, as its use 
under such conditions is apt to be followed by gangrene. 
If during the use of cold the skin becomes purple and congested, 
discontinue it at once. 

Cold may be used dry or wet. 

328 



HOUSEHOLD REMEDIES 329 

Dry cold is applied by means of an ice bag. A rubber bag 
is half filled with fine cracked ice. A towel, a piece of flannel 
or lint should be placed over the part first, as this will verve to 
absorb the moisture from the " sweating" of the ice bag. If 
the part to which the ice bag is to be applied is very tender, 
decrease the amount of ice in the bag to make it lighter or 
suspend the ice bag from a frame so that it touches the part 
only lightly. While the ice bag is being used, the part to which 
it is applied should be frequently inspected to watch the 
circulation. Do not fill the bag completely with the ice or hot 
water, and be sure to squeeze out the air so that the walls of 
the bag approximate above the ice or hot water. In this way 
the heat or cold is secured with a minimum amount of pressure. 
Such pressure becomes most uncomfortable 

Wet cold is applied by the use of cloths wrung out in ice 
water and frequently changed* or by evaporating solutions. 
Wet cold is more apt to macerate the skin and cause gangrene 
than dry cold. The part to which the wet cold is applied 
should be carefully watched and the cold removed if the skin 
becomes purple or congested. Lead water and laudanum, a 
saturated solution of epsom salts, or alcohol and water may be 
used as evaporating lotions. When such solutions are used 
they produce cold by rapid evaporation, and, therefore, the 
dressing should not be covered. 

Heat. — Heat may be employed as a hot bath, fomentations, 
poultices or dry heat. 

The continuous warm bath may be used in the treatment of 
a severe burn (page 139). 

A hot bath may be given to produce perspiration, and to 
react a victim of shock or collapse. 

The tub should be partly filled with water, the temperature 
of which is 100°F. The patient is immersed and the tempera- 
ture of the water is then raised to 110° to 115° by the addition 
of hot water. The patient should remain in the bath about 
fifteen minutes and then be placed in bed between blankets. 

Hot Mustard Bath. — Mustard added to the water of a bath 
acts as a stimulant. A mustard bath is useful in cases of shock 
other than from burns. One to two tablespoonfuls of mustard 
are added for each gallon of water used. The patient should 
not be kept in a mustard bath more than eight to ten minutes. 



330 TREATMENT OF EMERGENCIES 

A mustard foot bath is prepared by adding two or three 
tablespoonfuls of mustard to a bucket or foot tub of water at 
a temperature of 100° to 115°F. In this the patient soaks 
his feet ten to fifteen minutes. 

Hot Fomentations. — Hot fomentations are used to restore or 
maintain the vitality of a part which has been severely in- 
jured, to combat inflammation, and to relieve pain. A piece 
of flannel, surgical lint, or gauze (several layers in thickness) 
is soaked in water 120° to 130°. This is wrung out and placed 
over the part and covered with rubber dam or wax paper. A 
mass of cotton is placed over the rubber dam and a bandage is 
applied. The hot fomentation should be changed in about 
half an hour unless a hot water bag is placed over the fomenta- 
tion, in which case the fomentation should be changed every 
hour and a half. 

Antiseptic Fomentation or Antiseptic Poultice. — An anti- 
septic fomentation or antiseptic poultice is a fomentation 
which is made by soaking sterile gauze in a hot antiseptic 
solution, such as bichloride of mercury (1 to 1000) or a 2 per 
cent, solution of acetate of aluminum, wringing the gauze out 
and placing it upon the part. The gauze is covered with 
sterile rubber dam and a hot water bag. 

The Hot Pack. — To give a patient a hot pack cover the bed 
with a rubber sheet and on top of this place a dry heavy 
blanket. The patient, stripped, lies upon this blanket. A 
second blanket is soaked in water at a temperature of 115° 
to 120°F. wrung out and wrapped around the patient. Hot 
water bags, hot sand bags, hot water bottles, or hot bricks are 
placed around the blanket and a second dry blanket is 
thrown over him. 

An ice bag should be placed on the patient's head. The 
patient should remain in the pack half an hour to an hour. 

Poultices. — A poultice is a soft mass placed upon an area of 
inflammation to apply heat and moisture to produce softening 
and to relieve pain. An antiseptic poultice may be used to 
separate dead tissue or sloughing tissue from healthy tissue. 

Flaxseed Poultice. — A flaxseed poultice is made by adding 
to boiling water sufficient quantity of flaxseed to make a 
mixture the consistency of mush. This is then spread about 



HOUSEHOLD REMEDIES 331 

one-half inch thick upon a clean piece of linen or muslin and 
applied to the part. 

A small amount of olive oil spread over the skin to be 
covered with the poultice will prevent the poultice from 
adhering to the skin. 

The poultice should be covered with a rubber dam, oiled 
silk, or wax paper, and held in place with a binder or bandage. 

A poultice should not be left on a part too long, as it may 
cause blistering or vesication of the skin. 

Bread Poultice. — A bread poultice is made by making a 
mixture the consistency of mush with bread and boiling water. 
The mixture is then placed upon the part and covered with 
rubber dam, wax paper or oiled silk. 

Hop Poultice. — A hop poultice is made by soaking hop 
leaves in boiling water and then placing upon the part. 

Charcoal Poultice. — A charcoal poultice is sometimes used 
over sloughing, putrid wounds. It is prepared by adding a 
sufficient amount of equal parts of charcoal and flaxseed to 
boiling water to make a mixture the consistency of mush. 
This mixture is placed upon a piece of clean linen or muslin 
and applied to the part. It is then covered with a rubber 
dam, oiled silk or wax paper and held in place with a binder 
or bandage. 

Antiseptic Poultice or Antiseptic Fomentation. This has 
been discussed on page 330. 

Dry Heat.— L Diy heat is applied to a part by the application 
of hot water bags, hot water bottles, hot sand bags, or hot 
bricks. Great care must be used in the use of hot water bags 
if the patient is unconscious, or if the patient is paralyzed, 
or the skin anesthetic, in order to prevent burning the patient. 

Counterirritants. — Counterirritants are used to relieve the 
pain of deep-seated inflammation. They bring the blood 
to the surface of the skin and relieve the congestion of deeper 
structures. 

Mustard Poultice. — Take equal parts of mustard and flax- 
seed and add a sufficient quantity of the mixture to boiling 
water to make "mush." Spread this resulting mixture about 
one-half inch thick upon a piece of muslin or linen and apply 
to the part. 



332 TREATMENT OF EMERGENCIES 

Mustard Plaster. — A mustard plaster is made by taking 
equal parts of mustard and flour and adding sufficient quantity 
of cold water to make a paste. This is spread between two 
pieces of gauze, muslin or linen, and applied to the part. 

To apply a mustard plaster to a child, take 1 part of mustard 
and 3 parts of flour. 

The mustard plaster should remain on from ten minutes to 
half an hour, depending upon the effect produced. After 
removing the plaster apply vaseline, zinc ointment, or boric 
acid ointment, to the skin. 

Mustard plasters or papers may be purchased at a drug 
store. These should be dipped in cold water and applied to the 
part. As these plasters are very strong, a piece of muslin 
or linen should be interposed between the skin and the plaster. 

Cold water should be used in making a mustard plaster, as 
warm water renders the oil of mustard less efficient. 

Turpentine Stupe. — A turpentine stupe is prepared by dip- 
ping a piece of flannel in a pint of boiling water, to which has 
been added a tablespoonful of turpentine. The flannel thus 
saturated is thoroughly wrung out and applied to the area 
desired. The skin should be covered with a small amount of 
cosmolin or olive oil before the stupe is applied. The stupe 
should be applied for about five to ten minutes. 

Iodine. — The tincture of iodine may be used as a counter- 
irritant. It is applied with a camel's-hair brush. Do not 
cover the part with a bandage or binder, as it is apt to blister. 
If applied to a child or to a delicate skin, the iodine should be 
diluted with an equal part of alcohol. 

Spice Plaster. — A spice plaster is prepared by taking equal 
parts of ground ginger, cloves, allspice, and cinnamon, and 
adding to this mixture one-fourth part of cayenne pepper. 
After thoroughly mixing, enclose in a flannel bag. Wet the 
bag with whiskey or alcohol and apply to the part. 

Chloroform. — A few drops of chloroform applied to the 
skin by means of a small piece of flannel, linen or muslin, 
and covered with wax paper or oiled silk, will cause a rapid 
counterirritant effect in a few moments. 

Ammonia Water. — A piece of lint or flannel saturated with 
ammonia water and applied to the skin, and covered with 



HOUSEHOLD REMEDIES 333 

wax paper or oiled silk, will produce a rapid counterirritant 
effect. 

Fly Blister. — Great caution should be used in the applica- 
tion of a fly blister to the skin of a child or an elderly person. 
A fly blister should not be too large, nor should it remain upon 
the skin for too long a time. The danger of a fly blister is 
strangury — a condition causing frequent and painful urination, 
the urine often containing blood. 

A fly blister is made by spreading a small amount of ceratum 
cantharides upon a piece of adhesive plaster. A margin of 
about one-half inch of the adhesive plaster is left free of the 
cantharides in order to hold the plaster to the skin. 

The area of the cantharides should not be over one and one- 
half inches square, and should not be left on the skin more than 
five hours. After removing the plaster, dress the blister with 
vaseline or boric acid ointment. 

Enemata. — An enema is an injection of fluid into the lower 
bowel. 

A purgative enema is given to cause an evacuation of the 
bowels. 

A stimulating enema may be given in a case of shock when 
the patient is unable to swallow. 

An enema is given either with an ordinary fountain syringe 
or with a rectal tube connected with a glass funnel by a piece 
of rubber tubing. To give an enema cover the bed with a 
piece of rubber sheeting, or a folded sheet. The patient then 
lies on his left side, with the thighs flexed on the abdomen, the 
right thigh being flexed more than the left thigh. Fill the 
fountain syringe or the funnel, whichever is used, with the 
solution to be injected and expel air from the tubing by allow- 
ing some of the solution to flow through it. The rubber 
nozzle of the rectal tube should be well lubricated with vaseline 
or olive oil and inserted into the rectum about four inches. 
The bag or funnel is then raised two to three feet above the 
patient's buttocks and the fluid allowed to run into the rectum. 

Purgative Enemata. — A simple purgative enema consists of 
two to three pints of warm water well mixed with castile 
soap. The froth is removed from the mixture, and two to 
three pints of the solution is given. 



334 TREATMENT OF EMERGENCIES 

A compound enema consists of the warm water and soap, 
to which has been added an ounce of epsom salts, or a half 
ounce of turpentine, an ounce of glycerin, or an ounce of castor 
oil. 

Nutritive Enemata. — When a patient is unable to take food 
or drugs by the mouth they may be given in the form of a 
nutritive enema. The enema should be given warm, at a 
temperature of 98° or 100°F. The funnel should be held 
about two feet from the buttocks and the contents of the 
enema allowed to run in slowly. As the tube is withdrawn 
a gauze pad is held against the anus to prevent the enema from 
being expelled. The patient should lie quietly- on his back 
for an hour and try not to strain, and to retain the enema. 

A nutritive enema should contain about four ounces of 
fluid, and should be given every three to four hours and should 
always be preceded by a cleansing enema. 

Formulae of Nutritive Enemata. — The following are formulae 
of nutritive enemata : 

Three eggs beaten well in three ounces of peptonized milk. 

Three ounces of milk, two or three eggs, two or three pinches 
of salt, and a tablespoonful of red wine. 

The whites of two eggs, a half ounce of beef tea and four 
ounces of warm water. 

In the case of shock one of the best stimulant enemata con- 
sists of six ounces of hot coffee, to which is added an ounce of 
brandy or an ounce of whiskey. 

In the case of shock after the loss of a large amount of blood 
from hemorrhage a saline enema is an excellent form of 
treatment. A teaspoonful of salt is added to a pint of water 
which has been boiled. A pint or a quart of this solution is 
given. The solution should be given at a temperature of 
105° to 110°F. 



INDEX 



Abdomen, contusion of, 66 
treatment, G7 
wounds of, hemorrhage from, 
115 
Acetanilid as antiseptic, 202 

poisoning from, 323 
Acetate of aluminum as antiseptic, 
201 
of lead, poisoning from, 314 
Acetic acid, poisoning from, 310 
Acetonemia, treatment, 183 
Acid, acetic, poisoning from, 316 
boric, as antiseptic, 200 
carbolic, as antiseptic, 200 

poisoning from, 316 
fumes, asphyxia from smoke 

impregnated with, 151 
hydrochloric, poisoning from, 

316 
hydrocyanic, poisoning from, 

323 
nitric, poisoning from, 315 
oxalic, poisoning from, 316 
prussic, poisoning from, 323 
sulphuric, poisoning from, 315 
tartaric, poisoning from, 316 
Acids, poisonous, 315 
Aconite, poisoning from, 322 
Adhesive plaster dressing for 
sprained knee, 126 

method of removal, 126 
strapping in fracture of ribs, 
48 
Alcohol as disinfectant, 202 

poisoning from, 318 
Alcoholism, unconsciousness from, 

treatment, 176 
Alkalies as poisons, 317 
Almond oil, poisoning from, 323 
Alum as emetic, 311 

335 



Aluminum acetate as antiseptic, 

201 
Ambrine for burns, 139 
American method of bandaging 

foot, covering heel, 274 
Ammonia fumes, smoke impreg- 
nated with, asphyxia from, 150 
poisoning from, 317 
water as counter-irritant. 332 
Ankle, bandage of, figure-of-eight, 
271 
sprain of, Gibney dressing for, 
123 
Antikamnia, poisoning from, 323 
Antimony, poisoning from, 313 
Antipyrin, poisoning from. 323 
Antiseptic fomentations, 330 
poultices, 330 
solution, Carrel-Dakin, 73 
Antiseptics, 198 
Antitoxin, tetanus, injection of, 

83 
Antivenene serum in snake bites. 

86 
Apomorphin as emetic, 311 
Apoplexy, unconsciousness in, 179 

treatment, 180 
Aristol as antiseptic, 202 
Arm, bandages of, 257 
glass, 127 
lawn tennis, 127 
upper, bandage of, 255 
fracture of, 33 
diagnosis, 35 
dressing, 37 
treatment, 36 
wounds of, hemorrhage from, 
116 
Army tourniquet, 103 
Arsenic, poisoning from, 312 



336 



INDEX 



Arsenious acid poisoning, treat- 
ment, 312 
Arterial hemorrhage, 98 
Artificial respiration, 152 
Howard's method, 156 
in asphyxia from smoke, 148 
Laborde's method, 158 
lungmotor for, 159 
mechanical devices for, 159 
method of administration, 153 
precautions before, 153 
prone method, 155 
Shafer's method, 155 
Sylvester's method, 153 
tongue forceps for, 158 
Asphyxia, 145 
causes, 145 
from smoke, 145 

artificial respiration in, 148 
impregnated with acid fumes, 
151 
with ammonia fumes, 150 
with banana oil fumes, 150 
with illuminating gas fumes, 

148 * 
with spice fumes, 151 
oxygen in, 147 
stages, 146 
treatment, 146 
Asphyxiation, 145. See also As- 
phyxia. 
Aspirin, poisoning from, 323 
Assisting patient to walk, 291 
Atropine, poisoning from, 321 
Avulsion of extremities, 77 
of scalp, 76 

Back, strain of, treatment, 128 
Banana oil fumes, smoke impreg- 
nated with, asphyxia from, 150 
Bandage, Barton's, 231 
circular, 212 
cravat, 229 

for fracture of jaw, 29 
crossed, of both eyes, 237 

of one eye, 235 
demi-gauntlet, 253 
Desault, first roller, 249 



Bandage, Desault, second roller, 
247 

third roller, 250 
. three-roller, 248 
double T, 216 
figure-of-eight, 215 

in fracture of clavicle, 31 

of ankle, 271 

of both eyes, 237 
knees, 270 

of chest, anterior, 261 
posterior, 263 

of elbow, 257 

of forearm, 260 

of head and neck, 240 

of knee, 270 

of leg, 275 

of neck and axilla, 242 

of wrist and hand, 258 
for back of head, 231 
for forehead, 231 
four-tailed, for fracture of jaw, 

30 
gauntlet, 254 
Gibson's, 232 
initial extremity of, 210 
many-tailed, 219 
materials used for, 205 
method of removal, 211 
oblique, 212 

of ankle, figure-of-eight, 271 
of breasts, 266 

sling, 268 
of chest, 261 

figure-of-eight, anterior, 261 
posterior, 263 
of elbow, figure-of-eight, 257 
of fingers, 251 
of foot covering heel, 274 

not covering heel, 274 

spica, 276 
of forearm, 257 

circular, 259 

figure-of-eight, 260 

oblique, 259 

spiral, 259 
reverse, 260 
of hand, 251 



INDEX 



337 



Bandage of head, 231 
and jaw, 24 

V, 241 
and neck, figure-of-eight, 240 
recurrent longitudinal, 233 
transverse, 234 
of jaw, figure-of-eight, 270 

oblique, 238 
of leg, figure-of-eight, 27.") 
of lower extremity, 268 
spiral reverse, 274 
of neck and chest, anterior, 263 
of one breast, 265 
of shoulder, 243 
of toe, 275 
of upper arm, 255 
of wrist, circular, 257 
precautions for applying, 210 
recurrent, 215 
roller, in fracture of ribs, 17 

method of making, 200 
single T, 216 
spica, 215 

ascending, 243 

of groins, 268 
descending, 245 
of both groins, 268 
of buttock, 269 
of shoulder, 243 
of thumb, 254 
spiral, 213 
of finger, 251 
reversed, 214 
terminal extremity, 210 
varieties, 212 
Vclpcau, 245 
Bandaging, 205. See also Ban- 
dage. 
Barton's bandage, 231 
Bath, hot, 329 
mustard, 329 
warm water, in burns, 139 
Bed, carrying patient to, from 
stretcher, 305 
clothing, disinfection of, 203 
Belladonna, poisoning from, 321 
Bent fracture, 18 
Betanaphthol as antiseptic, 202 

22 



Bichlorid of mercury as antiseptic, 
199 ' 
poisoning from, 314 
Binder, 221 

of chest in fracture of ribs, 48 
Bites, chigger, 89 
treatment, 89 
frost, 144 
insect, 87, 88 

treatment, 87 
of poisonous spider-, 88 
snake, 84 

antivenene serum in, 86 
treatment, 85 
tick, treatment, 88 
Black eye, 63, 65 

treatment, 66 
Bleeding. Sec Hemorrhage. 
Blister, fly, 333 
Blood poisoning. 198 

vomiting of, 115 
Blue mass, poisoning from, 314 
rocket, poisoning from, 322 
stone, poisoning from, 313 
vitriol, poisoning from. 313 
Bone fragments, immobilization 

of, in simple fracture, 21 
Boric; acid as antiseptic, 200 
Brain, compression of, uncon- 
sciousness from, 17") 
concussion of, 24 
unconsciousness from. 174 
Bread poultices, 331 
Breast, bandage of, 265 

sling, 268 
Breasts, bandage of, 266 
Breathing, stertorous, in uncon- 
sciousness, 174 
Bromo-seltzcr, poisoning from, 323 
Brucine, poisoning from, 321 
Bruise, 63. See also Contusions. 
Bullet, military, wounds from, 94 
gas-gangrene from, 96 
infection in, 95 
treatment, 96 
non-jacketed, wounds from, 

treatment, 94 
soft-nose, wounds from, 96 



338 



INDEX 



Burnett's disinfecting fluid, poi- 
soning from, 314 
Burns, 136 

about eyes, 142 

about mouth and throat, 141 

ambrine for, 139 

by chemicals, 141 

degrees of, 136 

of first degree, dangers of, 137 

pain in, 136 

picric acid gauze for, 139 

proper method of dressing, 139 

sequels of, 138 

symptoms, 136 

treatment, formula for, 140 
local, 138 

warm water bath in, 139 
Buttock, bandage of, spica, 269 

Calcium, poisoning from, 318 
Calomel, poisoning from, 314, 

326 
Cannabis indica, poisoning from, 

326 
Cantharides, poisoning from, 323 
Capillary hemorrhage, 99 
Carbolic acid as antiseptic, 200 
dressings, precautions in use, 

73 
poisoning from, 316 
Carbon monoxide, poisoning from, 

324 
Carbonic acid gas, poisoning from, 

324 
Carrel-Dakin antiseptic solution, 

73 
Carrying patients, 277 
by extremities, 300 
fire carry, 291 
four-handed carry, 299 
from stretcher to bed, 305 
pick-a-back, 291 
stretchers for, 300 
three-handed seat for, 299 
two-handed seat for, 291 
Cartridge, blank, wounds from, 96 

treatment, 97 
Caustic, lunar, poisoning from, 314 



Cerebrospinal fluid, escape of, in 

basal fracture of skull, 24 
Chair stretcher, 305 
Charcoal fumes, poisoning - from, 
324 
poultices, 331 
Charriere's tourniquet, 106 
Chemicals, burns by, 141 
Chest, bandage of, 261 

anterior figure-of-eight, 261 
posterior figure-of-eight, 263 
binder in fracture of ribs, 48 
contusion of, 66 

wounds of, hemorrhage from, 114 
Chigger bites, 88 

treatment, 89 
Chilblain, 143 

Childhood, convulsions in, 170 
Chloral, poisoning from, 320 
Chloride of zinc as antiseptic, 201 

poisoning from, 314 
Chloroform as counter-irritant, 332 

poisoning from, 318 
Circular bandage, 212 
of forearm, 259 
of wrist, 257 
Clavicle, fracture of, 30 
dressings, 31 
prevention of deformity after, 

32 
treatment, 31 
Clothing, bed, disinfection of, 203 
Coal gas, poisoning from, 324 
Coal-tar products, poisoning from, 

323 
Coat stretcher, 304 
Cocain in foreign bodies in eye, 193 

poisoning from, 322 
Colchicum, poisoning from, 326 
Cold, dry, 329 
local use of, 328 
wet, 329 
Collar bone, fracture of, 30 
dressings, 31 
prevention of deformity in, 

32 
treatment, 31 
Colles' fracture, 42 



INDEX 



339 



Coma, 172 
causes, 172 
duo to epilepsy, 176 
I reatment, 177 
from diabetes, treatment. 183 
in opium poisoning, 181 

treatment, 182 
in uremia, treatment, 182 
medical examination in, 173 
Comminuted fracture, 18 
Compound fracture, 17 

antiseptic treatment, 21 
prevention of further damage 

in, 21 
primary, 18 
secondary, 18 
Compression of brain, unconscious- 
ness from, 175 
Concussion of brain, 24 

unconsciousness in, 171 
Conium, poisoning from, 327 
Contused wounds, 67 
dressing, 73 
iodine in, 70 
treatment, 68 
Contusions, 63 

discoloration in, 63 
Epsom salts solution in, 64 
iserol in, 65 

leadwater and laudanum in, 64 
of abdomen, 66 
treatment, 67 
of chest, 66 
of eyelids, 65 
of solar plexus, 67 
of special parts, 65 
of spine, 67 
symptoms, 63 
treatment, 64 
Convulsions, 169 
due to disease, 170 
to epilepsy, 169 
to head injury, 169 
from hysteria, 170 
from lcck-jaw, 170 
from strychnine poisoning, 170 
from tetanus, 170 
in childhood, 170 



Convulsions, treatment, 171 

Copper, poisoning from, treat- 
ment, 313 
sulphate as emetic, 311 

Corrosive sublimate as antiseptic, 
199 
poisoning from, 314 

Cough medicines, poisoning from. 
319 

Counterirritants, 331 

Cravat bandage, 229 
for jaw fracture, 29 

Creolin as antiseptic, 201 

Creosote, poisoning from, 316 

Crepitus in fracture, 19 

Crossed bandage of both eyes 
Of one eye. 235 

Croton oil, poisoning from, 325 

Cut throat, 79 

hemorrhage from, 113 
treatment, 79 

Cyanid of potassium, poisoning 
from, 323 

Dakin-Carrel antiseptic solu- 
tion, 73 
Deformity in fracture, 20 

prevention of, in fracture of 
clavicle, 32 
Demi-gauntlet bandage, 253 
Depressants, poisoning from. 322 
Desault bandage, first roller. 249 
second roller, 249 
third roller, 250 
three-roller, 248 
Diabetes, coma from, treatment. 

183 
Direct force, fracture by. 17 
Discoloration in contusion, 63 
Disinfection of bed clothing, 203 
of excreta, 203 
room, 203 
Dislocation, 129 
compound, 129 

treatment, 130 
of elbow, treatment, 133 
of fingers, treatment, 134 
of hip, 133 



340 



- INDEX 



Dislocation of hip, treatment, 134 
of lower jaw, 130 

treatment, 131 
of shoulder, 132 

treatment, 133 
of thumb, 134 

treatment, 135 
of toes, 135 
simple, 129 

treatment, 129 
symptoms, 129 
Dissection wounds, 89 
Donovan's solution, poisoning 

from, 312 
Dosage, equivalents in, 328 
Double T bandage, 216 
Dover's powder, poisoning from, 

319 
Dressing, carbolic acid, precau- 
tions in use of, 73 
Mayor's handkerchief, 222 
Drowning, 162 
rescuing in, 163 

methods of breaking holds, 
163-166 
of carrying, 166-168 
treatment, 162 
Dry heat, 331 

Ear, foreign bodies in, treatment, 
193 
hemorrhage from, 112 
insect in, treatment, 88 
Ecchymosis in basal fracture of 

skull, 24 
Elbow, bandage of, figure-of-eight, 
257 
dislocation of, treatment, 133 
Elbow-joint, fracture in and 

around, 37 
Electric shock, effects of, 185 
prevention, 186 
treatment, 187 
wires, precautions to take re- 
garding, 188 
Emetics in poisoning, 311 
Enemata, 333 
compound, 334 



Enemata, nutritive, 334 

purgative, 333 
Epilepsy, coma due to, 176 
treatment, 177 
convulsions due to, 169 
Epistaxis, 111 

in basal fracture of skull, 24 
Epsom salts solution in contusion, 

64 
Equivalents in dosage, 328 
Ergot, poisoning from, 325 
Ether, poisoning from, 319 
Excitomotor poisoning, 321 
Excreta, disinfection of, 203 
Exhaustion, heat, treatment, 181 
Extremities, avulsion of, 77 

lower spiral reverse bandage of, 
274 
wounds of, hemorrhage from, 
120 
upper, wounds of, hemorrhage 
from, 116 
Eye, black, 63, 65 
treatment, 66 
crossed bandage of, 235 
foreign bodies in, 191 
cocain in, 193 
treatment, 192 
Eyelids, contusion of, 65 
Eyes, burns near, 142 
crossed bandage of, 23.7 
figure-of-eight bandage of, 237 

Face, hemorrhage from, 112 
incised wounds of, 78 
laceration of, 74 
Fainting, 172, 178 

treatment, 179 
Femur, fracture of, 52 

treatment, 53 f 
Fibula, fracture of, 58 

treatment, 60 
Figure-of-eight bandage, 215 
anterior, 261 
in fracture of clavicle, 31 
of ankle, 271 
of both eyes, 237 
knees, 270 



INDEX 



341 



Figure-of-eight bandage of chest, 

anterior, 261 
posterior, 263 
of elbow, 257 
of forearm, 2G0 
of head and neck, 240 
of knee, 270 
of leg, 275 

of neck and axilla, 242 
of wrist and hand, 258 
Fingers, bandages of, 251 
dislocation of, treatment, 134 
fracture of, 44 

treatment, 44 
spiral bandage of, 251 
Fire carry, 291 
First-aid package, 70 

treatment of fracture, 21 
of individual hones, 22 
Fish hooks, wounds from, 83 

stings, 89 
Fits, 109. See also Convulsions. 
Flaxseed poultices, 330 
Fly blister, 333 
Fomentations, antiseptic, 330 

hot, 330 
Foot, bandage of, covering heel, 
274 
not covering heel, 274 
spica, 276 
fracture of, 61 

treatment, 62 
hemorrhage from, 121 
Forearm, bandage of, 257 
circular, 259 
figure-of-eight, 260 
oblique, 259 
spiral, 259 
reverse, 260 
fracture of, 37 

treatment, 38 
wounds of, hemorrhage from, 
118 
Forehead, bandage for, 231 
Foreign bodies in ear, treatment, 
193 
in eye, 191 

treatment, 192 



Foreign bodies in eye, cocain in, 
193 

in nose, treatment, 194 
in throat, 194 
symptoms, 194 
treatment, 195 
swallowed, treatment, 196 
Formalin as disinfectant. 202 
Four-handed carry, 299 
Four-tailed bandage for fracture 

of jaw, 30 
Fowler's solution, poisoning from, 

312 
Fracture, 17 
bent, 18 

by direct force, 17 
by indirect force, 17 
by muscular action, 17 
Colics', 42 
comminuted, 18 
compound, 17 

ant iseptic treat incut . 21 
prevention of further damage 

in, 21 
primary, IS 
secondary, 18 
crepitus in, 19 
definition, 17 
deformity in, 20 
green-stick. Is 

in and about elbow-joint, 37 
incomplete, 18 
loss of function in, 20 
multiple, IS 
of clavicle, dressings, 31 

prevention of deformity after, 

32 
treatment, 31 
of collar bone, 30 

prevention of deformity in, 

32 
treatment, 31 
of femur, 52 

treatment, 52 
of fibula, 5S 

treatment, 60 
of fingers, 44 
treatment, 44 



342 



INDEX 



Fracture of foot, 61 
treatment, 62 
of forearm, 37 

treatment, 38 
of hand, 43 

treatment, 43 
of humerus, 33 
diagnosis, 35 
dressing, 37 
treatment, 36 
of individual bones, 22 
of knee cap, 56 

treatment, 58 
of leg, 58 
of lower jaw, 28 

dressings for, 29 
treatment, 28 
of nasal septum, 28 
of nose, 26 
dressing, 28 
treatment, 27 
of patella, 56 

treatment, 58 
of pelvis, 52 
of radius, 37 

treatment, 38 
of ribs, 45 

complications, 46 
dressing, 48 
treatment, 46 
of scapula, 44 

treatment, 45 
of shoulder blade, 44 

treatment, 45 
of skull, 22 
basal, 23 

concussion of brain in, 25 
ecchymosis in, 24 
epistaxis in, 24 
hemorrhage in, 23 
treatment, 25 
diagnosis, 23 
escape of cerebrospinal fluid 

in, 24 
varieties, 22 
vault, 22, 25 
treatment, 26 
of spine, 49 



Fracture of' spine, transportation 
of patient in, 50 
of thigh, 52 

treatment, 53 
of tibia, 58 

treatment, 60 
of toes, 61 

treatment, 62 
of ulna, 37 

treatment, 38 
of upper arm, 33 
diagnosis, 35 
dressing, 37 
treatment, 36~ 
pain in, 19 

preternatural mobility in, 20 
reduction, 20 
setting, 20 
simple, 17 

immobilization of bone frag- 
ments in, 21 
sprain, 122 
symptoms, 18 
tenderness in, 19 
unnatural mobility in, 20 
French method of bandaging foot 

not covering heel, 274 
Frost bites, 144 
Function, loss of, in fracture, 20 

Gas-gangrene from military bul- 
let-wounds, 96 

Gases, poisoning from, 324 

Gasoline as disinfectant, 202 

Gauntlet bandage, 254 

Germicides, 198 

Gibney dressing for sprained ankle, 
123 

Gibson's bandage, 232 

Glass arm, 127 

Goulard's extract, poisoning from, 
314 

Green-stick fracture, 18 

Groin, bandage of, ascending spica, 
268 

Groins, bandage of, spica, 268 

Gum camphor, poisoning from, 
326 



INDEX 



343 



Gums, laceration of, 74 
hemorrhage from, 112 

Gunshot wounds, 92 
varieties, 92 

Hand, bandages of, 251 

fracture of, 43 
treatment, 43 

palm of, hemorrhage from, 119 
Handkerchief dressing, Mayor's. 

222 
Hashish, poisoning from, 320 
Head and jaw, V bandage of, 241 

and neck, figure-of-eight band- 
age of, 240 

back of, bandage for, 231 

bandage of, 231 

recurrent longitudinal, 233 
transverse, 234 

injury, convulsions due to, 109 
unconsciousness from, 171 
treatment, 175 

protector, Peerless, 282 
Heat, dry, 331 

exhaustion, treatment, 181 

local use of, 329 

stroke, treatment, 180 
Hematemesis, 115 
Hematoma, 64 

Hemlock, poisoning from, 327 
Hemorrhage, 98 

after extraction of tooth, 116 

arrest of, nature's method, 101 

arterial, 98 

capillary, 99 

constitutional symptoms, 100 
treatment, 109 

from basal fracture of skull, 23 

from cut throat, 113 

from ear, 112 

from extensive wounds, 102 

from face, 112 

from foot, 121 

from lacerated gums, 112 

from male urethra, 115 

from nose, 111 

from palm of hand, 119 

from particular regions, 111 



Hemorrhage from rectum, 115 
from scalp wounds, 111 
from uterus, 116 
from varicose veins of leu, 121 
from vein, 98 

treatment, 108 
from womb, 116 
from wounds of abdomen, 115 
of chest, 114 
of forearm. 1 18 
of lower extremities, 120 
of upper arm, 116 
extremities, 116 
hot compress in, 109 
local treatment, principles of, 

101 
oxygen hunger in, KM) 
shock in, treatment, 109 
stimulants in, 110 
tourniquets for, 102 
varieties, 98 
Henbane, poisoning from, 326 
I Icroin, poisoning from. 319 
Hip, dislocation of, 134 

treatment, 134 
Hop poultice, 331 
Hot bath, 329 
mustard, 329 
compress in hemorrhage, 109 
fomentations, 330 
pack, 330 
Household remedies, 328 
Howard's method of artificial 

respiration, 156 
Humerus, fracture of, 33 
diagnosis, 35 
dressing, 37 
treatment, 36 
Hydrochloric acid, poisoning from, 

316 
Hydrocyanic acid, poisoning from, 

323 
Hydrogen peroxid as antiseptic, 

201 
Hydrophobia, 89 
treatment, 90 
Pasteur, 91 
Hyoscyamus, poisoning from, 326 



344 



INDEX 



Hysteria, convulsions from, 170 
unconscious in, treatment, 178 

Ice bag, use of, 329 
Ices, cheap, poisoning from, 312 
Illuminating gas fumes, smoke 
impregnated with, 
asphyxia from, 148 
treatment, 149 
poisoning, 152 
Immobilization of bone fragments 

in simple fracture, 21 
Incised wounds, 77 
of face, 78 
of special parts, 78 
treatment, 78 
Incomplete fracture, 18 
Indian hemp, poisoning from, 326 
Indirect force, fracture by, 17 
Infant lungmotor, 159 
Insect bites and stings, 87, 88 

treatment, 87 
Insects in ear, treatment, 88 
Iodine as antiseptic, 201 
as counter-irritant, 332 
in contused and lacerated 

wounds, 70 
poisoning from, 325 
Iodoform as antiseptic, 201 

poisoning from, 325 
Ipecac as emetic, 311 
Iserol in contusion, 65 

Jaw, bandage of, oblique, 238 
lower, dislocation of, 130 
dislocation, treatment, 131 
fracture of, dressings for, 29 
treatment, 28 

Kerosene, poisoning from, 318 
Knee, bandage of, figure-of-eight, 
270 
sprain of, adhesive plaster dress- 
ing, 126 
Knee-cap, fracture of, 56 

treatment, 58 
Knock-out drops, poisoning from, 

320 
Knuckles, laceration of, 75 



Laborde's method of artificial 

respiration, 158 
Lacerated wounds, 67 
dressing, 73 
iodine in, 70 
treatment, 68 
Laceration of face, 74 
of gums, 74 
of knuckles, 75 
of lips, 74 
of scalp, 74 
of special parts, 74 
Laudanum, poisoning from, 319 
Lawn tennis arm, 127 
Lead, poisoning from,- treatment, 

314 
Leadwater and laudanum in con- 
tusion, 64 
Leg, bandage of, figure-of-eight, 
275 
fracture of, 58 
Lemon, salts of, poisoning from, 

316 
Lethargy, 172 

Levis' splint for dislocation of 
phalanges, 134 
for fractures of forearm, 41 
Lightning stroke, 184 
after-effects, 184 
precautions against, 184 
treatment, 185 
Lime, poisoning from, 318 
Lips, laceration of, 74 
Lock-jaw, convulsions from, 170 
Longitudinal recurrent bandage of 

head, 233 
Lunar caustic, poisoning from, 314 
Lungmotor, 159 
infant, 159 
Lye, poisoning from, 318 
Lysol as disinfectant, 202 

Many-tailed bandage, 219 
Marsh gas, poisoning from, 324 
Mayor's handkerchief dressing, 222 
Mercury bichlorid as antiseptic, 
199 
poisoning from, 314 



INDEX 



345 



Metal poisons, 312 
Mobility, preternatural, * in frac- 
ture, 20 

unnatural, in fracture, 20 
Monk's-hood, poisoning from, 322 
Morphine, poisoning from, 319 
Motor-cycle stretcher, 306 

Mouth, burns near, 141 
Multiple fracture, 18 
Muscarin, poisoning from, 324 
Muscle strain, 127 
symptoms, 127 
treatment, 127 

action, fracture by, 17 
Mushrooms, poisoning from, 324 
Mustard as disinfectant, 203 

bath, hot, 329 

poultices, 331 

Narcosis, 172 

Narcotics, poisoning from, 319 
Neck and axilla, figure-of-eight 
bandage of, 242 
and chest, bandage of, anterior, 
263 
Nightshade, deadly, poisoning 

from, 321 
Nitrate of potassium, poisoning 
from, 318 
of silver, poisoning from, 314 
Nitric acid, poisoning from, 315 
Nose, foreign bodies in, treatment. 
194 
fracture of, 26 
dressing, 28 
treatment, 27 
hemorrhage from, 111 
Nutritive enemata, 334 
Nux vomica, poisoning from, 321 

Oblique bandage, 212 
of forearm, 259 
of jaw, 238 
Oil, croton, poisoning from, 325 
of almonds, poisoning from, 328 
of turpentine, poisoning from, 

318 
of vitriol, poisoning from, 315 



Opium, poisoning from, 319 
coma in. 181 
treatment, 182 
Oxalic acid, poisoning from, 316 
Oxygen hunger in hemorrhage, 100 
in asphyxia from smoke, 1 17 

Pack, hot, 330 

Pain in fracture. 19 
Paraffine, poisoning from, 318 
Paregoric, poisoning from. 319 
Paris green, poisoning from. 312 
Pasteur treatment of rabies. 91 
Patella, fracture of, 56 

treatment. 58 
Patients, transportation of, 277- 
309 

Peerless head protector, 282 

Pelvis, fracture of, 52 
Permanganate of potassium as 

antiseptic, 201 
Peroxid of hydrogen as antiseptic, 

201 
Petit "s spiral tourniquet, 105 
Phenacetin, poisoning from. 323 

Phenol as antiseptic, 200 

poisoning from, 316 
Phosphorus, poisoning from, 317 
Picric acid gauze for burns, 138 
Plaster, mustard, 332 

spice, 332 
Poisoning, 310 

blood, 198 

emetics in, 311 

excitomotor, 321 

from aeetanilid, 323 

from acetic acid, 316 

from aconite, 322 

from alcohol, 3 IS 

from almond oil, 323 

from ammonia. 317 

from antikamnia, 323 

from antimony, 313 

from antipyrin, 323 

from arsenic, 312 

from arsenious acid, 312 

from aspirin, 323 

from atropin, 321 



346 



INDEX 



Poisoning from belladonna, 321 
from bichloride of mercury, 314 
from blue mass, 314 

rocket, 322 

stone, 313 

vitriol, 313 
from bromo-seltzer, 323 
from brucine, 321 
from Burnett's disinfecting fluid, 

314 
from calcium, 318 
from calomel, 314 
from camphor, 326 
from cannabis indica, 326 
from cantharides, 324 
from carbolic acid, 316 
from carbon monoxide, 324 
from caustic potash, 318 
from charcoal fumes, 324 
from cheap ices, 312 
from chloral, 320 
from chloride of zinc, 314 
from chloroform, 318 
from coal gas, 324 
from cocaine, 322 
from colchicum, 326 
from conium, 327 
from copper, 313 
from corrosive sublimate, 314 
from cough medicines, 319 
from creosote, 316 
from croton oil, 325 
from cyanid of potassium, 323 
from deadly nightshade, 321 
from depressants, 322 
from Donovan's solution, 312 
from Dover's powder, 319 
from ergot, 325 
from ether, 319 
from Fowler's solution, 312 
from gases, 324 
from Goulard's extract, 314 
from gum camphor, 326 
from hashish, 326 
from hemlock, 327 
from henbane, 326 
from heroin, 319 
from hydrochloric acid, 316 



Poisoning from hydrocyanic acid, 

323' 
from hyoscyamus, 326 
from illuminating gas, 152 
from Indian hemp, 326 
from iodine, 325 
from iodoform, 325 
from kerosene, 318 
from knock-out drops, 320 
from laudanum, 319 
from lead, treatment, 314 
from lime, 318 
from lunar caustic, 314 
from lye, 318 
from marsh gas, 324 
from mercuric chloride, 314 
from mercury, 314 
from metals, 312 
from monk's-hood, 322 
from morphine, 319 
from muscarin, 324 v 
from mushrooms, 324 
from narcotics, 319 * 
from nitrate of silver, 314 
from nitric acid, 315 f 
from nux vomica, 321 
from oil of turpentine, 318 

of vitriol, 315 
from opium, 319 

coma in, 181 
treatment, 182 
from oxalic acid, 316 
from paraffine, 318 
from paregoric, 319 
from Paris green, 312 
from phenacetin, 323 
from phenol, 316 
from phosphorus, 317 
from potassium nitrate, 318 
from prussic acid, 323 
from salt petre, 318 
from salts of lemon, 316 
from sewer gas, 324 
from sodium potash, 318 
from soothing syrups, 319 
from Spanish flies, 323 
from strychnine, 321 

convulsions from, 170 



INDEX 



347 



Poisoning from sugar of lead, 
314 

from sulphuric acid, 315 

from tartar emetic, 313 

from tartaric acid, 316 

from vapor of ammonia, 317 

from volatile liquids, 318 

from water gas, 324 

from white vitriol, 314 

from wine of antimony, treat- 
ment, 313 

from wolf's-bane, 322 

prevention of, 310 

ptomaine, 324 

stomach-tube in, 311 

treatment, general, 311 
necessities for, 327 
Poison-bottles, 310 
Poisoned wounds, 84 
Poisons, 310 

acid, 315 

alkalies, 317 

metal, 312 

miscellaneous, 323 
Potash, caustic, poisoning from, 

318 
Potassium cvanid, poisoning from, 
323 

nitrate, poisoning from, 318 

permanganate as antiseptic, 201 
Poultices, antiseptic, 330 

bread, 331 

charcoal, 331 

flaxseed, 330 

hop, 331 

mustard, 331 
Prone method of artificial respira- 
tion, 155 
Prussic acid, poisoning from, 323 
Ptomaine poisoning, 324 
Punctured wounds, 80 

tetanus from, prevention, 83 
treatment, 81 
Purgative enemata, 333 

Rabies, 89 
treatment, 90 
Pasteur, 91 



Radius, fracture of, 37 

treatment, 38 
Rectum, hemorrhage from, 115 
Recurrent bondage, 215 

of head, longitudinal, 233 
transverse, 234 
Remedies, household, 328 
Respiration, artificial, 152. See 

also Artificial respiration. 
Ribs, fracture of, 45 

compli eat ions, 4f> 

dressing, 48 

treatment, 46 
Roller bandage in fracture of ribs. 
47 

method of making, 206 
Room, disinfection, 203 

Salt pet re, poisoning from. 318 
Salts of Lemon, poisoning from. 316 
Sayre dressing in fracture of 

clavicle, 31 
Scalds, 130 
Scalp, avulsion of, 76 

laceration of, 74 

wounds, hemorrhage from. 111 
Scapula, fracture of, 44 

treatment, 45 
Scorpion stings, 88 
Sepsis, 198 

Sewer gas, poisoning from, 324 
Shafer's method of artificial respira- 
tion, 155 
Shock, electric, effects of, 105 
prevention, 186 
treatment, 187 

in hemorrhage, treatment, 109 
Shot-gun, wounds from, 97 

treatment, 97 
Shoulder, bandages of, 243 

blade, fracture of, 44 
treatment, 45 

dislocation of, 132 
treatment, 133 

spica bandage of, 243 
Silver nitrate, poisoning from, 314 
Simple fracture, 17 
Single T-bandage, 216 



348 



INDEX 



Skull, fracture of, 22 
basal, 23 

concussion of brain in, 25 

ecchymosis in, 24 

escape of cerebrospinal fluid 

in, 24 
hemorrhage in, 23 
treatment, 25 
diagnosis, 23 
epistaxis in, 24 
varieties, 22 
vault, 22, 25 
treatment, 26 
Sling bandage of breast, 268 
Slings, 221 
Smoke, asphyxia from, 145 

artificial respiration in, 148 
effects, 145 
oxygen in, 147 
stages, 146 
treatment, 146 
impregnated with acid fumes, 
asphyxia from, 151 
with ammonia fumes, as- 
phyxia from, 150 
with banana oil fumes, as- 
phyxia from, 150 
with illuminating gas fumes, 
asphyxia from, 148 
treatment, 149 
with spice fumes, asphyxia 
from, 151 
toleration of, 145 
varieties from different sub- 
stances, 145 
Snake bites, 84 

treatment, 85 
Snakes, poisonous, varieties, 84 
Sodium potash, poisoning from, 

318 
Solar plexus, contusion of, 67 
Soothing syrups, poisoning from, 

319 
Spanish flies, poisoning from, 323 

windlass tourniquet, 105 
Spasms, 169 
Spica bandage, 215 
ascending, 243 



Spica bandage, descending, 245 
of both groins, 268 
of buttock, 269 
of foot, 276 

of groin, ascending, 268 
of shoulder, 243 
of thumb, 254 
Spice fumes, asphyxia from smoke 
impregnated with, 151 
plaster, 332 
Spiders, poisonous, bites, 88 
Spine, contusion of, 67 
fracture of, 49 

transportation -of patient in, 
50 
Spiral bandage, 213 
of finger, 251 
of forearm, 259 
reversed bandage, 214 
of forearm, 260 
of lower extremity, 274 
Splint for fracture of thigh, 55 

Levis, for fractures of forearm, 41 
Sprain, 122 
fracture, 122 
of ankle, Gibney dressing for, 

123 
of knee, adhesive plaster dress- 
ing, 126 
symptoms, 122 
treatment, 122 
Stab wounds, 83 

Stertorous breathing in uncon- 
sciousness, 174 
Stimulants in hemorrhage, 110 
Stings of fishes, 89 
insect, 87, 88 

treatment, 87 
scorpion, 88 
Stomach-tube in poisoning, 311 
Stone, blue, poisoning from, 313 
Strain, muscle, 127 
symptoms, 127 
treatment, 127 
of back, treatment, 128 
Stretcher, carrying patient to bed 
from, 305 
chair, 305 



INDEX 



349 



Stretcher, coat, 304 

motor-cycle, 300 

rules for carrying, 306 
Stretchers, 300 ' 

varieties, 300 
Stroke, apoplectic, 179 
treatment, 180 

heat, treatment, 180 

lightning, 184 
after-effects, 184 
precautions against, 184 
treatment, 185 

sun, treatment, 180 
Strychnine, poisoning from, 321 

convulsions in, 170 
Stupe, turpentine, 332 
Stupor, 172 

Sugar of lead, poisoning from, 314 
Sulphate of copper as emetic, 311 

of zinc as emetic, 311 
Sulphuric acid, poisoning from, 315 
Sunburn, 143 
Sunstroke, treatment, 181 
Swallowed foreign bodies, treat- 
ment, 196 
Sylvester's method of artificial 

respiration, 153 
Syncope, 172, 178 

treatment, 179 * 

Tartar emetic, poisoning from, 313 
Tartaric acid, poisoning from, 316 
T bandage, double, 216 

single, 216 
Teeth, laceration of knuckles from 

blow on, 75 
Tenderness in fracture, 19 
Tetanus, convulsions in, 170, 

from punctured wounds, preven- 
tion, 83 
Thermic fever, treatment, ISO 
Thiersch's fluid as antiseptic, 201 
Thigh, fracture of, 52 

treatment, 53 
Three-handed seat for carrying 

patients, 299 
Three-roller bandage of Desault, 

248 



Throat, burn.- near, 141 

cut, 79 

hemorrhage from, 1 13 
treatment, 79 

foreign bodies in, 191 
symptoms, 191 
treatment, 196 
Thumb, bandage of, spies, 251 

dislocation of, 13-1 
treatment. 135 
Tibia, fracture of, 58 

treatment, 60 
Tick bites, treatment 
Toes, bandage of, 275 

dislocation of, 135 

fracture of, 61 
treatment, 62 
Tongue forceps for use in artificial 

respiration, 15s 
Tooth, extraction of, hemorrhage 

after, 116 
Tourniquet, army. 103 

( Sharriere's, 106 

improvised, 105 

length of application, 1<> S 

methods of application, 106 

Petit 's spiral. 105 

Spanish windlass. 105 

varieties, 102 
Tracheotomy in smoke asphyxia, 

151 
Transportation of patients. 277- 

309 
Transverse recurrent bandage of 

head, 234 
Turpentine stupe, 332 
Two-handed seat for carrying 

patients, 291 

Ulna, fracture of, 37 

treatment, 38 
Unconsciousness, 172 

from alcoholism, treatment, 176 
from compression of brain, 175 
from head injuries, 174 

treatment, 175 
in apoplexy, 179 
treatment, ISO 



350 



INDEX 



Unconsciousness in concussion of 
brain, 174 

in hysteria, 177 

method of examination in, 173 

stertorous breathing in, 174 
Uremia, coma in, treatment, 182 
Urethra, male, hemorrhage from, 

115 
Uterus, hemorrhage from, 116 

Vapor of ammonia, poisoning 

from, 317 
Varicose veins of leg, hemorrhage 

from, 121 
V bandage of head and jaw, 241 

and neck, 240 
Vein, hemorrhage from, 98 

treatment, 108 
Veins of leg, varicose, hemorrhage 

from, 121 
Velpeau bandage, 245 
Vitriol, blue, poisoning from, 313 

oil of, poisoning from, 315 

white, poisoning from, 314 
Volatile liquids, poisoning from, 

318 
Vomiting of blood, 115 

Water gas, poisoning from, 324 
White vitriol, poisoning from, 314 
Wine of antimony, poisoning from, 

treatment, 313 
Wires, electric, precautions to 

take regarding, 188 
Wolf's-bane, poisoning from, 322 
Womb, hemorrhage from, 116 
Wounds, 63 
contused, 67 
dressing, 73 
iodine in, 70 
treatment, 68 
dissection, 89 

extensive, hemorrhage from, 102 
from blank cartridge, 96 

treatment, 97 
from fish hooks, 83 



Wounds from military bullet, 94 
gas-gangrene from, 96 
infection in, 95 
♦ treatment, 96 

from non-jacketed bullet, treat- 
ment, 94 
from shot-gun, 97 

treatment, 97 
from soft-nose bullets, 96 
gunshot, 92 

varieties, 92 
incised, 77 

of face, 78 

of special parts, 78 

treatment, 78 
lacerated, 67 

dressing, 73 

iodine in, 70 

treatment, 68 
of abdomen, hemorrhage from, 

115 
of chest, hemorrhage from, 114 
of extremities, hemorrhage from, 

116 
of forearm, hemorrhage from, 

118 
of lower extremities, hemorrhage 

from, 120 
of upper arm, hemorrhage from, 
116 

extremities, hemorrhage from, 
116 
poisoned, 84 
punctured, 80 

tetanus from, prevention, 83 

treatment, 81 
scalp, hemorrhage from, 111 
stab, 83 
Wrist, bandage of, circular, 257 
and hand, figure-of-eight band- 
age of, 258 



Zinc chlorid as disinfectant, 201 
poisoning from, treatment, 314 
sulphate as emetic, 311 



SAUNDERS' BOOKS 



Practice, Pharmacy, 
Materia Medica, Thera- 
peutics, Pharmacology, 
and the Allied Sciences 

W. B. SAUNDERS COMPANY 

West Washington Square Philadelphia 

9, Henrietta Street Covent Garden, London 

Our Handsome Complete Catalogue will be Sent You on Request 

Medical Clinics of Chicago 

Issued serially, one octavo of 200 pages, illustrated, every other 
month. Per Clinic Year (July to May), six numbers: Cloth, si 2. 00 net. 

EXCLUSIVELY INTERNAL MEDICINE 

These bi-monthly publications are devoted exclusively to Clinical Internal 
Medicine in all its departments. They give you the bedside and amphitheater 
teachings of leading Chicago internists, representing such large hospitals as 
Mercy, Cook County, St. Luke's, Michael Reese, and Sarah Morris Memorial. 
The widest variety of cases is included, bringing out forcibly every feature of 
history-taking, diagnosis, treatment, and general management. The cases 
are illustrated with jr-ray pictures, photographs, pulse-tracings, and temper- 
ature charts ; the technic of all laboratory tests is given in detail, and every 
aid that can serve to make the diagnosis and treatment of the cases thoroughly 
clear to the general practitioner is emphasized. These publications are clin- 
ical in the strictest sense — they are an exposition of diagnosis and treatment as 
actually practiced at the bedside and in the amphitheater. 



SAUNDERS' BOOKS ON 



Musser and Kelly's Treatment 



Practical Treatment. By 108 eminent specialists. Vol- 
umes I, II y and III, edited by John H. Musser, M.D., and A. O. 
J. Kelly, M. D. Each an octavo of 950 pages, illustrated. 
Cloth, $6.00 net; Half Morocco, $7.50 net. Volume IV, edited 
by John H. Musser, Jr., M. D., and Thomas C. Kelly, M. D. 
Octavo of 1000 pages, illustrated. Cloth, $7.00 net. 

VOLUME IV— All the New Treatments— JUST OUT 

The newest developments of the past few years constitute the subject- 
matter of Volume IV. Bacteriology, electro- and rontgen- therapy, the 
endocrine glands, serum therapy, emetin, pituitary extract, pollen protein 
in hay-fever, synthetic chemistry, starvation treatment in diabetes, diver- 
ticulitis, intestinal stasis, artificial pneumothorax in tuberculosis, Schick 
test in diphtheria, Dakin's solution, occupational diseases, acidosis — these 
are but a few of the topics that make this book the Treatment that will 
give you more service — better service — than any other. 

The Medical Record 

" The most modern and advanced views are presented. It is difficult to pick out any 
one topic that deserves special commendation, all parts fully covering their particular field, 
and written with that fulness of detail demanded by the every-day needs of the practitioner." 



Thomson's Clinical Medicine 

Clinical Medicine. By William Hanna Thomson, M.D., 
LL. D. , formerly Professor of the Practice of Medicine and of 
Diseases of the Nervous System, New York University Medical 
College. Octavo of 667 pages. Cloth, $5.00 net; Half Moroc- 
co, $6.50 net. 

A RECORD OF 50 YEARS 

This new work represents over a half century of active practice and teach- 
ing. It deals with bedside medicine — the application of medical knowledge 
for the relief of the sick. First the meaning of common and important symp- 
toms is stated definitely ; then follows a chapter on the use of remedies and 
a classification of them ; next the section on infections, and last a section on 
diseases of particular organs and tissues. An important chapter is that on the 
mechanism of surface chill and "catching cold," going very clearly into the 
etiologic factors, and outlining the treatment. The chapter on remedies takes 
up non-medicinal and medicinal remedies and vaccine and serum therapy. 
The infectious diseases are taken up in Part II, while Part III deals with 
diseases of special organs or tissues, every disease being fully presented from 
the clinical side. 



PRACTICE OF MEDICINE 



Tousey's Medical Electricity, 
Rontgen Rays, and Radium 

Medical Electricity, Rontgen Rays, and Radium. By 

Sinclair Tousey, M. D., Consulting Surgeon to St. Bar- 
tholomew's Hospital, New York. Octavo of 12 19 pages, with 
801 illustrations, 19 in colors. Cloth, $7.50 net; Half 
Morocco, $9.00 net. 

SECOND EDITION, RESET 

The revision for this edition was extremely heavy ; new matter ha? increased 
the size of the book by some 100 pages. About 50 new illustrations have been 
added. The new matter added includes : Diathermy, sinusoidal currents, 
radiography with intensifying screens, rontgenotherapy, the Coolidge and 
similar Rontgen tubes and the author's method of dosage, and radium therapv. 
The book has been enriched by including several of Machado's tabular 
classifications of electric methods, effects, and uses. 

Throughout the entire work everything concerning electricity, x-rays, and 
radium in medicine, as well as phototherapy, i^ explained in detail — nothing 
is omitted. It tells you how to equip your office, and, more than that, how to 
use your apparatus, explaining away all difficulties. It tells you just how to 
apply these measures in the treatment of disease. The chapters on dental 
radiography are particularly valuable to those interested in dental work. 



Abbott's Medical Electricity 

Medical Electricity. By George Knapp Abbott, 
M. D., Dean and Professor of Physiologic Therapy and 
Practice, College of Medical Evangelists, Loina Linda, Cali- 
fornia. 121110 of 132 pages, illustrated. Cloth, $1.25 net. 

This new work gives the nurse the essentials of this subject. Dr. 
Abbott's style has made the difficult simple. The text is illustrated. 



SAUNDERS' BOOKS ON 



Gant's Work on Diarrhea 

Diarrhea, Inflammatory and Parasitic Diseases of the 
Gastrointestinal Tract, By Samuel G. Gant, M. D. , LL. D. , 
Professor of Diseases of the Sigmoid Flexure, Colon, Rectum, 
and Anus, New York Post-Graduate Medical School and Hospital. 
Octavo of 604 pages, with 181 illustrations. Cloth, $6.00 net; 
Half Morocco, $7.50 net. 

ILLUSTRATED 

This new work is particularly full on the two practical phasesof the subject 
— diagnosis and treatment. For instance : While the essential diagnostic 
points are given under each disease, a fuller description of diagnostic methods 
is given in a special chapter. The differential diagnosis of diarrheas of local 
and those of systematic disturbances is strongly brought out. There is a 
special chapter on nervous diarrheas and those originating from gastrogenic 
and enter ogenic dyspepsias. You get the psychotherapy of psychic diarrheas. 
You get reliable methods of simultaneously controlling associated constipation 
and diarrhea. You get a complete formulary — prescriptions from Dr. Gant's 
own practice. There is a chapter on hookworms, tapeworms and round 
worms, and on the diarrheas caused by them and other parasites. This chap- 
ter contains many excellent illustrations. The limitations of drugs are pointed 
out, the dangers of their use emphasized, and the indications for surgical 
intervention given. You get the technic in detail of all surgical procedures 
indicated — fully illustrated. 



Gant's Intestinal Stasis (Constipation and Obstruction) 

This work is medical, non-medical (mechanical), and surgical, the lat- 
ter really being a complete work on rectocolonic surgery. The chapters 
on therapeutic gymnastics and massage are the outgrowth of Dr. Gant's 
personal experience. You get practical articles on diverticulitis, peri- 
diverticulitis, pericolitis, perisigmoiditis (Jackson 's membrane), Lane 1 s 
kink, and affections of the ileocecal valve. 

Octavo of 575 pages, with 250 illustrations. By Samuel G. Gant, M. D., LL. D., 
New York Post-Graduate Medical School and Hospital. Cloth, $6.00 net ; Half 
Morocco, $7.50 net. 

" The best and most complete treatise on these subjects." — Medical 
Record. 



DIAGNOSIS AND TREATMENT 



Cabot's Differential Diagnosis 

Differential Diagnosis. Presented through an analysis of 
385 Cases. By Richard C. Cabot, M.D., Assistant Professor of 
Clinical Medicine, Harvard Medical School. Two octavos of 
750 pages each, illustrated. Per volume : Cloth, $6.00 net; Half 
Morocco, $7.50 net. 

VOLUME I [New (3d) Edition— Just Out] : Headache, pain in various 
regions, fevers, chills, coma, convulsions, weakness, cough, vomiting, hema- 
turia, dyspnea, jaundice, and nervousness — 21 symptoms and 385 cases. 

VOLUME 2 : Treats of abdominal and other tumors, vertigo, diarrhea, 
dyspepsia, hematemesis, enlarged glands, blood in stools, swelling of face, 
hemoptysis, edema of legs, frequent micturition and polyuria, fainting, hoarse- 
ness, pallor, swelling of arm, delirium, palpitation and arhythmia, tremor, 
ascites and abdominal enlargement — 19 symptoms and 317 cases. 



Morrow's Diagnostic and 
Therapeutic Technic 



Diagnostic and Therapeutic Technic. By Albert S. 
Morrow, M.D., Adjunct Professor of Surgery, New York Poly- 
clinic. Octavo of 830 pages, with 860 original line drawings. 
Cloth, $5.50 net. 

SECOND EDITION 

Dr. Morrow's new edition is decidedly a work for you — the physician en- 
gaged in general practice. It is a work you need because it tells you just 
how to perform those procedures required of you every day, and it tells you 
and shows you by clear, new line-drawings, in a way never before approached. 
The information it gives is such as you need to know every day — transfusion 
and infusion, hypodermic medication, Bier's hyperemia, exploratory punc- 
tures, aspirations, anesthesia, etc. 

Journal American Medical Association 

" The procedures described are those which practitioners may at some time be called 
on to perform." 



SAUNDERS' BOOKS ON 



Garrison's History of Medicine 

History of Medicine. With Medical Chronology, Biblio- 
graphic Data, and Test Questions. By Fielding H. Garrison, 
M. D., Principal Assistant Librarian, Surgeon-General's Office, 
Washington, D. C. Octavo of 763 pages, illustrated. Cloth, 
$6.00 net; Half Morocco, $7.50 net. 

THE BAEDEKER OF MEDICAL HISTORY 

The work begins with ancient and primitive medicine, and carries you in 
a most interesting and instructive way on through Egyptian medicine, Sumerian 
and Oriental medicine, Greek medicine, the Byzantine period; the Mohamme- 
dan and Jewish periods, the Medieval period, the period of the Renaissance, 
the Revival of learning and the Reformation ; the Seventeenth -Century (the 
age of individual scientific endeavor), the Eighteenth Century (the age of 
theories and systems), the Nineteenth Century (the beginning of organized ad- 
vancement of science), the Twentieth Century (the beginning of organized 
preventive medicine). You get all the important facts in medical history; a 
biographic dictionary of the makers of medical history, arranged alphabetically; 
an album of medical portraits; a complete medical chronology (data on dis- 
eases, drugs, operations, etc.); a brief survey of the social and cultural phases 
of each period. 



McKenzie on Exercise | e Z' 

Exercise in Education and Medicine. By R. Tait 
McKenzie, B. A., M. D., Professor of Physical Education, and 
Director of the Department, University of Pennsylvania. Oc- 
tavo of 585 pages, with 478 illustrations. Cloth, $4.00 net. 

D. A. Sargent, M. D., Director of Hemeniuay Gymnasium, Harvard University. 

"It cannot fail to be helpful to practitioners in medicine. The classification of athletic 
games and exercises in tabular form for different ages, sexes, and occupations is the work of 
an expert. It should be in the hands of every physical educator and medical practitioner." 



Carter's Diet Lists 

Diet Lists of the Presbyterian Hospital of New York City. 
Compiled, with notes, by Herbert S. Carter, M. D. i2mo of 129 
pages. Cloth, $1.00 net. 

Bonney's Tuberculosis second Edition 

Tuberculosis. By Sherman G. Bonney, M.D., Professor of 
Medicine, Denver and Gross College of Medicine. Octavo of 955 pages, 
with 243 illustrations. Cloth, $7.00 net ; Half Morocco, $8.50 net. 



THE PRACTICE OF MEDIC/.YE 



Anders' 
Practice of Medicine 

A Text-Book of the Practice of Medicine. Bv James 

M. Anders, M. D., Ph. D., LL. D., Professor of Medicine, 
University of Pennsylvania. Octavo, 1332 pages, illustrated. 
Cloth, $5.50 net; Half Morocco, S7.00 net. 

NEW (12th) EDITION 

The success of this work is no doubt due to the extensive consideration 
given to Diagnosis and Treatment, under Differential Diagnosis the point of 
distinction of simulating diseases being presented in tabular form. In this 
new edition Dr. Anders has included all the most important advances in 
medicine, keeping the book within bounds by a judicious elimination of 
obsolete matter. A great many articles have also been rewritten. 

Wm. E. Quine, M. D., College of Physicians and Surgeons, Chicago. 

"I consider Anders' Practice one of the best single-volume works before the profession 
at this time, and one of the best text-books for medical students.' 



DaCosta's Physical Diagnosis 

Physical Diagnosis. By John C. DaCosta, Jr., Asso- 
ciate Professor of Medicine, Jefferson Medical College. Octavo 
of 589 pages, with original illustrations. Cloth, S3. 50 net. 

NEW (3d) EDITION 

In Dr. DaCosta's work every method given has been carefully tested and 
proved of value by the author himself. Normal physical signs are explained 
in detail in order to aid the diagnostician in determining the abnormal. Both 
direct and differential diagnosis are emphasized. The 243 original illustra- 
tions are artistic as well as practical. 

Henry L. Eisner, M. D., Professor of Medicine, Syracuse University 

"I have reviewed this book and am thoroughly convinced that it is one of the best 
ever written on the subject. In every way I find it a superior production."' 



SAUNDERS' BOOKS ON 



Strouse & Perry's Food Manual 
for Doctor and Patient 

A Food Manual for Doctor and Patient. By Solomon 
Strouse, M. D., Professor of Medicine, Post-Graduate Medical 
School, Chicago; and Maude A. Perry, B. S., Dietitian Michael 
Reese Hospital. i2mo of 275 pages. 

READY SOON 

This manual contains 232 diets and menus, and 125 special recipes, 
supplying a thorough dietetic treatment for all the nutritional diseases. 
Diets are given for diabetes (starvation treatment), gout, nephritis, high 
blood-pressure, kidney stone, diseases of the stomach, intestines, liver, gall- 
stones, tuberculosis, fevers, skin affections, obesity, anemia, etc. 



Friedenwald & Ruhrah on Diet 

Diet in Health and Disease. By Julius Friedenwald, 
M. D. , Professor of Diseases of the Stomach, and John Ruhrah, 
M. D., Professor of Diseases of Children, College of Physicians 
and Surgeons, Baltimore. Octavo of 85 7 pages. Cloth, $4.00 net. 

FOURTH EDITION 

Dietetic management in all diseases in which diet plays a part in treat- 
ment is carefully considered, the articles on diet in diseases of the digestive 
organs containing numerous diet lists and explicit instructions for administra- 
tion. The feeding of infants and children, of patients before and after anes- 
thesia and surgical operations, are all taken up in detail. 

" It seems to me that you have prepared the most valuable work of the kind now avail- 
able. I am especially glad to see the long list of analyses of different kinds of food." — 
George Dock, M. D., Tulane University of Louisiana. 



Eggleston's Prescription Writing 



This new work is a crystallization of Dr. Eggleston's long experience 
in teaching this subject. It covers the entire field in a most practical way, 
taking up grammar, construction, dosage, vehicles, incompatibility, ad- 
ministration, etc. 

i6mo of 115 pages. By Cary Eggleston, M. D., Instructor in Pharmacology at 
Cornell University Medical School. Cloth $1.00 net. 



PRACTICE OF MEDICINE 



Kemp on Stomach, 
Intestines, and Pancreas 

Diseases of the Stomach, Intestines, and Pancreas. 

By Robkrt Coleman Kemp, M. D., Professor of Gastrointes- 
tinal Diseases at the New York School of Clinical Medicine. 
Octavo of 1096 pages, with 428 illustrations. Cloth, $7.00 net ; 
Half Morocco, $8.50 net. 

NEW (3d) EDITION— JUST READY 

It is the practitioner who first meets with these cases, and it is he upon 
whom the burden of diagnosis rests. After the diagnosis is established, the 
practitioner, if properly equipped, could frequently treat the case himself 
instead of transferring it to a specialist. This work is intended to equip the 
practitioner with this end in view. 

The Therapeutic Gazette 

" The therapeutic advice which is given is excellent. Methods of physical and 
chemical examination are adequately and correctly described." 



D&stedo's Materia Medica, Pharmacology, 
Therapeutics, and Prescription AVriting 

By W. A. Bastedo, M. D., Associate in Pharmacology and 
Therapeutics at Columbia University. Octavo of 602 pages, 
illustrated. Cloth, S3. 50 net. 

FIFTH LARGE PRINTING 

Dr. Bastedo' s new work has the distinct advantage of presenting the 
subjects from both the laboratory and the clinical sides. Dr. Bastedo for 
many years devoted his entire time to laboratory work. Now, however, he 
is strictly a clinical man. He gives you the practical, daily application of that 
information he gleaned at first hand in the laboratory — facts you can use in 
your bedside practice. Because of this early laboratory training you are 
assured that his book is correct according to laboratory standards. Being 
now a strictly clinical man, you know that his book is modeled with the common 
purpose of all medical practice : The treatment of the sick. 



io SAUNDERS' BOOKS ON 

Faught's Blood-Pressure 

Blood-Pressure from the Clinical Standpoint. By 

Francis A. Faught, M. D., formerly Director of the Laboratory 
of Clinical Medicine of the Medico-Chirurgical College of Phila- 
delphia. Octavo of 478 pages, illustrated. Cloth, $3.25 net. 

NEW (2d) EDITION 

Dr. Faught's book is designed for practical help at the bedside. It meets 
the urgent needs of the general practitioner, who heretofore had no book to 
which to turn in case of emergency. Every effort has been made to provide 
here a practical guide, full of information of- a clinical nature, and presented 
in a way readily available for daily use by the busy man. Besides the actual 
technic of using the sphygmomanometer in diagnosing disease, Dr. Faught 
has included a brief general discussion of the process of circulation. The 
practical application of sphygmomanometric findings within recent years makes 
it imperative for every medical man to have close at hand an up-to-date work 
on this subject. ^^^^^^^^ 

Anders and Boston's Medical 
Diagnosis 

A Text-Book of Medical Diagnosis. By James M. An- 
ders, M. D., Ph. D., LL.D., Professor of Medicine, and L. 
Napoleon Boston, M. D., Professor of Physical Diagnosis, 
University of Pennsylvania. Octavo of 1248 pages, with 466 
illustrations. Cloth, $6.00 net. 

SECOND EDITION 

This new work is designed expressly for the general practitioner. The 
methods given are practical and especially adapted for quick reference. The 
diagnostic methods are presented in a forceful, definite way by men who have 
had wide experience at the bedside and in the clinical laboratory. 

The Medical Record 

" The association in its authorship of a celebrated clinician and a well-known labora< 
tory worker is most fortunate. It must long occupy a pre-eminent position." 



PRACTICE OF MEDICINE 



Deaderick & Thompson's Endemic Diseases of South 

Endemic Diseases of the Southern States. By William 
H. DEADERICK, M. D., Member American Society of Tropical Medicine; 
and LOYD THOMPSON, M. D., Charter Member American Association of 
Immunologists. Octavo of 546 pages, illustrated. Cloth, S5.00 net \ 
Half Morocco, $6.50 net. 

This new work is really a collection of monographs on malaria, blackwater fever 
pellagra, amebic dysentery, hookworm disease, and other intestinal parasites 
Diagnosis, prophylaxis, and treatment are gone into in detail, giving you every aid to 
the correct interpretation of the symptoms presented, and every modern means of 
value in the prevention and treatment of the diseases discussed. 



Smith's What to Eat and Why Second Edition 

What to Eat and Why. By G. Carroll Smith, M. D., Boston. 
1 2mo of 377 pages. Cloth, #2.75 net. 

With this book you no longer need send your patients to a specialist to be dieted— 
you will be able to prescribe the suitable diet yourself, just as you do other forms oi 
therapy. Dr. Smith gives 'the why" of each statement he makes. It is this knowing 
why which gives you confidence in the book, which makes you feel that Dr ^mith 
knows. 



Ward's Bedside Hematology 

Bedside Hematology. By Gordon R. Ward, M. D., Fellow of 
the Royal Society of Medicine, London. England. Octavo of 304 
pages, illustrated. Cloth. $3.50 net. 

Slade's Physical Examination & Diagnostic Anatomy 

Physical Examination and Diagnostic Anatomy. Bv Charles 
B. Slade, M. D.. Chief of Clinic in General Medicine, University and 
Bellevue Hospital Medical College. i2mo of 150 pages, illustrated 
Cloth, $1.25 net. New 2d 1 Edition 

Fenwick's Dyspepsia 

Dyspepsia. By William Soltau Fenwick, M.D., of London. Octavo 
of 485 pages, illustrated. Cloth, S3. 00 net. 

Todd's Clinical Diagnosis New (3d) Edition 

Clinical Diagnosis. By James Campbell Todd, M. D., Professor 
of Pathology, University of Colorado. Denver. i2mo of sS^ na^e* 
illustrated. Cloth. $2.50 net. ' 



SAUNDERS' BOOKS ON 



Norris & Landis' 
Physical Diagnosis 

Physical Diagnosis. Part I: By George William 
Norris, A. B., M. D., Associate in Medicine at the University 
of Pennsylvania. Part II: By H. R. M. Landis, A.B., M. D., 
Director of Clinical and Sociological Department of the Phipps 
Institute, Philadelphia. Octavo of iooo pages, with 417 illus- 
trations, mostly original. 

This work presents an admirable combination of the theory and appli- 
cations of physical diagnosis. It is complete down to the last detail. The 
first part takes up the methods in themselves. Inspection, palpation, per- 
cussion, and auscultation are completely covered in the examination both 
of the lungs and of the heart. The second part takes up the particular 
diseases of the bronchi, of the lungs, of the pleura, diaphragm, pericardium, 
heart and aorta, and shows you exactly how to determine the diagnosis 
by the symptoms and findings. You get here the application of the four 
methods to your daily clinical work. 



Carman & Miller's 
X-ray Diagnosis 

Rontgen Diagnosis of Disease of the Alimentary 
Canal. By Russell D. Carman, M. D., Head of Section on 
Rontgenology, and Albert Miller, M. D., Second Assistant 
in Section on Rontgenology, Division of Medicine in The Mayo 
Clinic, Rochester, Minn. Octavo of 558 pages, with 504 illus- 
trations. 

This work takes up the diagnosis of disease of the alimentary tract, 
following its course from the esophagus to the rectum. You are told what 
apparatus is needed, and exactly how to use it, with formulas for the barium 
meal and enema. You are given the Rontgen appearance of the normal 
organ under discussion, what appearances signify abnormality, and exactly 
how to detect abnormality. Then you get the rontgenologic symptoms of 
every disease of the organ, followed by several actual examples of each to 
show individual variations, and an extensive bibliography on every topic. 
A few of the important topics treated are early cancer, diverticula, gastrop- 
tosis, "hunger-pain" in duodenal ulcer, Lane's kinks, auto-intoxication, 
and intestinal stasis. 



THERAPEUTICS AXD MATERIA MEDICA 



Hinsdale's Hydrotherapy 

Hydrotherapy : A Treatise on Hydrotherapy in General ; 
Its Application to Special Affections; the Technic or Processes 
Employed, and the Use of Waters Internally. By Guy Hinsdale, 
M. D., Fellow of the Royal Society of Medicine of Great Britain. 
Octavo of 466 pages, illustrated. Cloth, S3. 50 net. 

The Medical Record 

" We cannot conceive of a work mor'- useful to the general practitioner than this, nor 
one to which he would resort more frequently for reference and guidance in his daily 
work." 



Kelly's Cyclopedia of American 
Medical Biography 

Cyclopedia of American Medical Biography. By How- 
ard A. Kelly, M. D., Johns Hopkins University. Two octavos 
of 525 pages each, with portraits. Per set : Cloth, 810.00 net; 
Half Morocco, $13.00 net. 

Dr. Kelly, in these two handsome volumes, presents concise, vet com- 
plete biographies of those men and women who have contributed notewor- 
thy ly to the advancement of medicine in America. Dr. Kelly's reputation for 
painstaking care assures accuracy of statement. There are about one thousand 
biographies included. 



Amy's Pharmacy 



New (2d) Edition 



Principles of Pharmacy. By Henry V. Arny, Ph. G., 

Ph. D., Professor of Chemistry, New York College of Phar- 
macy. Thoroughly revised and reset throughout. Based on 
the ninth edition of the United States Pharmacopoeia and the 
fourth revision of the National Formulary. Octavo of 1056 
pages, with 246 illustrations. Cloth, $5.50 net; Half Morocco, 
$7.00 net. 

Bohm and Painter's Massage 

Massage. By Max Bohm, M. D., of Berlin, Germany. Edited, 
with an Introduction, by Charles F. Painter, M. D., 'Professor of 
Orthopedic Surgery at Tufts College Medical School, Boston. Octavo 
of 91 pages, with 97 practical illustrations. Cloth, $1.75 net. 



14 SAUNDERS' B00JC3 OAT 

GET A*r%£x*lr+<±*% THE NEW 

THE BEST iTmeriCall STANDARD 

Illustrated Dictionary 

The New (8th) Edition, Reset 

The American Illustrated Medical Dictionary. By W. A. 

Newman Dorland, M. D., Editor of "The American Pocket 
Medical Dictionary." Octavo of 1 137 pages. Flexible leather, 
$4.50 net; with thumb index, $5.00 net. 

OVER 1500 NEW WORDS 

Howard A. Kelly, M. D., Johns Hopkins University, Baltimore. 

" Dr. Dorland's dictionary is admirable. It is so well gotten up and of such conve- 
nient size. No errors have been found in my use of it." 



Just 
Out 



Sollmann's Pharmacology 

A Manual of Pharmacology: Its Applications to Therapeutics 
and Toxicolqgy. By Torald Sollmann, M. D., Professor of Pharma- 
cology and Materia Medica in the School of Medicine of Western Reserve 
University, Cleveland. Octavo of 901 pages, illustrated. Cloth, $4.50 net. 

MANIIAT ^is * s ^ e text or re ^ erence volume. Throughout the 

work the relation of pharmacology to the practice of 
medicine is forcibly emphasized. Those drugs that you actually use in 
your practice are discussed extensively, while those used less frequently are 
dismissed with less consideration. All the new remedies are included, with 
detailed instructions for their use: Vaccines, serums, salvarsan, neosalvar- 
san, pituitary extract, emetin — all those new remedies of the Pharmacopoeia 
being so extensively discussed and employed. Every worthwhile develop- 
ment in the field of pharmacology is included. 

LABORATORY GUIDE, ^™ise S mthis£^y 

Guide present no difficulty in 
technic, and require little help from the instructor. They teach you how 
to teach yourself. Special stress is laid on facts with direct practical bear- 
ing. " Technical Notes" are introduced for more detailed information for 
the instructor and investigator. 

A Laboratory Guide in Pharmacology. By Torald Sollmann, M. D. 
Octavo of 355 pages, illustrated. Cloth, $2.50 net. 



MATERIA ME DIC A AND THERAPEUTICS. 15 

American Pocket Dictionary New (9thj Edit i on 

The American Pocket Medical Dictionary. Edited by W. 
A. Newman Dorland, M.D. Flexible leather, with gold edges, $125 
net ; with thumb index, $1.50 net. 

Cohen and Eshner's Diagnosis. Second Revised Edition 

Essentials of Diagnosis. By S. Sous-Cohen, M. D., and A. A. 
ESHNER, M. D. Post-octavo, 382 pages ; 55 illustrations. Cloth, $1.25 
net. In Saunders' Question- Compend Series. 

Seventh 

Morris' Materia Medica and Therapeutics Edition 

Essentials of Materia Medica, Therapeutics, and Prescrip- 
tion-Writing. By Henry Morris, M.D. Revised by W. A. Bas- 
TEDO, M. D., Instructor in Materia Medica and Pharmacology, Columbia 
University. i2mo, 300 pages. Cloth, $1.25 net. Saunders' Compends. 

Deaderick on Malaria 

Practical Study of Malaria. By William II. Dfaderick, 
M. D., Member American Society of Tropical Medicine. Octavo of 
402 pages, illustrated. Cloth, $4.50 net. 

Goepp's State Board Questions New 4th) Edition 

State Board Questions and Answers. By R. Max Goepp, 

M. D-, Professor of Clinical Medicine, Philadelphia Polyclinic. Octavo 
of 715 pages. Cloth, $4.25 net. 

Niles on Pellagra New < 2d ) Edition 

Pellagra. By George M. Niles, M. D., Gastro-enterologist to 
the Georgia Baptist Hospital, Atlanta. Octavo of 253 pages, illustrated. 
Cloth, $3.00 net. 

Arnold's Medical Diet Charts 

Medical Diet Charts. Prepared by H. D. Arnold, M. D., 
Professor of Clinical Medicine, Tufts Medical College, Boston. Single 
charts, 5 cents; 50 charts, #2.00 net; 500 charts, £iS.oo net; 1000 
charts, $30.00 net. 

Thornton's Dose- Book Fourth Edition 

Dose-Book and Manual of Prescription Writing. By E. Q. 
Thornton, M. D., Assistant Professor of Materia Medica, Jefferson 
Medical College, Philadelphia. Post-octavo, 410 pages, illustrated. 
Flexible leather, $2.00 net. 

Lusk on Nutrition Second Edition 

Elements of the Science of Nutrition. By Graham Lusk, 
Ph. D., Professor of Physiology in Cornell University Medical School. 
Octavo of 402 pages. Cloth, $3.00 net. 

" I shall recommend it highly. It is a comfort to have such a discussion of the 
subject."— Lewellys F. Barker, M. D., Professor of the Principles and Practice of 
Medicine, Johns Hopkins University. 



1 6 SAUNDERS' BOOKS ON 

Stevens' Therapeutics Fifth Edition 

A Text-Book of Modern Materia Medica and Therapeutics. 
By A. A. Stevens, A.M., M.D., Lecturer on Physical Diagnosis- in the 
University of Pennsylvania. Octavo of 675 pages. Cloth, $3.50 net. 

Dr Stevens' Therapeutics is one of the most successful works on the subject ever 
published. In this new edition the work has undergone a very thorough revision, 
and now represents the very latest advances. 

The Medical Record, New York 

" Among the numerous treatises on this most important branch of medical practice, 
this by Dr. Stevens has ranked with the best." 

Butler's Materia Medica Sixth Edition 

A Text-Book of Materia Medica, Therapeutics, and Pharma- 
cology. By George F. Butler, Ph.G., M.D., Professor and Head 
of the Department of Therapeutics and Professor of Preventive and 
Clinical Medicine, Chicago College of Medicine and Surgery, Medical 
Department Valpariso University. Octavo of 702 pages, illustrated. 
Cloth, #4.00 net; Half Morocco, $5.50 net. 

For this sixth edition Dr. Butler has entirely remodeled his work, a great part hav- 
ing been rewritten. All obsolete matter has been eliminated, and special attention 
has been given to the toxicologic and therapeutic effects of the newer compounds. 

Sahli's Diagnostic Methods Second Edition, Reset 

A Treatise on Diagnostic Methods of Examination. By Prof. 
Dr. H. Sahli, of Bern. Edited by Nath'l Bowditch Potter, M. D., 
Columbia University. Octavo of 1225 pages, profusely illustrated. 
Cloth, $6.50 net. 

Saunders* Pocket Formulary Ninth Edition 

Saunders' Pocket Medical Formulary. By William M. Powell, 
M. D. Containing 1900 formulas from the best-known authorities. 
In flexible leather, with side index, wallet, and flap. $1.75 net. 

Camac's Epoch- Making Contributions 

Epoch-making Contributions to Medicine and Surgery. By 
C. N. B. Camac, M. D. of New York City. Octavo of 450 pages, 
with portraits. Artistically bound, $4.00 net. 

Stevens' Practice of Medicine New (loth) Edition 

A Manual of the Practice of Medtcine. By A. A. Stevens, 
A. M., M. D., Professor of Therapeutics and Clinical Medicine, 
Woman's Medical College, Philadelphia. Post-octavo, 629 pages, 
illustrated. Cloth, $2.50 net. 



